RCM Contract Support Specialist

🔥 14 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Integrated Home Care Services, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2015

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Integrated Home Care Services, Inc. is an integrated home care benefits manager that coordinates and manages value-based home health services, durable medical equipment, and home infusion for patients and members on behalf of health plans and providers. It provides network development and credentialing, utilization management, claims adjudication, analytics, and a technology-enabled platform for referrals, real-time documentation, and 24/7 access to services, aiming to reduce costs, improve outcomes, and streamline administration for payers, providers, and patients.

📋 Description

• Lead and deliver projects related to development and configuration of new business, insurance contracts, provider contracts, new pricing, and editing • Manage enhancements, compliance, and system enhancements • Ensure ongoing activities follow established policies, procedures, state regulations, and contractual provisions • Collaborate with system vendors, IT, and integration teams to troubleshoot configuration limitations, defects, and enhancements • Assess financial impact of configuration decisions and errors • Manage major system configuration projects, including claims business rule setup and outlier management • Monitor payer, regulatory, and coding updates and adjust system configuration proactively • Perform quality reviews of completed configuration and manage remediation of discrepancies • Collaborate with billing management to resolve claim issues and make corrections • Provide support to the billing team and related business areas • Create help sheets and training materials • Review data after system implementation to ensure configuration accuracy • Assist process owners and stakeholders with recommendations and results presentation • Identify and analyze trends from claims configuration requests, problem reports, and inquiries • Recommend improvements to existing work processes • Monitor configuration-driven metrics including denial rates, AR aging, and underpayments

🎯 Requirements

• Ability to interpret insurance contract pricing tables and additional business requirements • Ability to translate standard business requirements into detailed functional requirements • Ability to collaborate with system vendors, IT, and integration teams • Knowledge of revenue integrity and compliance requirements • Ability to manage major system configuration projects, including claims business rule setup and outlier management • Ability to monitor payer, regulatory, and coding updates • Ability to perform quality reviews of completed configuration and remediate discrepancies • Ability to resolve claim issues caused by system configuration • Ability to create help sheets and training materials • Ability to review post-implementation data for configuration accuracy • Ability to analyze claims configuration requests, problem reports, and inquiries • Ability to monitor denial rates, AR aging, and underpayments • Team player; works well as a member of a group • Self-starter capable of working without outside help

🏖️ Benefits

• Medical, Vision, Dental, Short- and Long-term insurance • 6+ Days of Holidays Pay • 17 days of PTO • Employer paid life insurance • 401K with employer contribution • Wellness program with reward incentives • Employee recognition and reward programs • Comprehensive paid training program