RCM Precertification Specialist

ReFocus Eye Health is searching for an RCM Precertification Manager with 2-5 years of work experience to join our organization as we scale for current and future growth and conduct the overall revenue cycle and finance mission. The ideal candidate will have experience in full cycle RCM and understand the importance of pre certifications in the healthcare space. This position is full time at either the Waterbury, CT location or remote. This position will report to the Vice President of Revenue Cycle.

In this role, the Manager of Precertification is responsible for developing, implementing, and maintaining the Precertification processes for all Refocus; managing, identifying, and working with other RCM and business leaders to identify and correct operating issues to optimize and maximize success for our business partners.

Responsibilities include:

· Own the development of precertification’s to drive reduction in denials specific to authorizations.

· Analyze RCM denial trends and make recommendations for improvement and cost savings.

· Complete analysis of RCM certification activities

· Develop and review rejection and denial management around authorizations and collaborate on improvements.

· Drive process improvements

· Ensure review and accuracy of escalation metrics and daily production.

· Develop business case, supporting analysis and presentation to support process changes.

· Serve as primary contact for authorization discussions with Physicians, Practice Admins, Operations leaders, and RCM senior management.

Qualifications:

· 5-7 years of related full cycle RCM experience and/or training or equivalent combination of education and experience

· Exceptional written, verbal, and interpersonal communication skills required.

· Knowledge of billing systems and prior authorization processes

· Strong RCM operational skills

· Expertise in medical billing, front end, claim submission, medical insurance policies and healthcare business processes.

· Results driven approach, setting measurable goals for self and team, and holding self and other accountable.

· Excel skills such as ability to use formulas to analyze data, create and format pivot tables and templates.

ReFocus is offering a generous benefits and compensation package to the right candidate. ReFocus Eye Health is not just vision. It is visionary. We are funded by Zenyth Partners, a permanent capital investment firm committed to providing transformative solutions that address the changing needs of healthcare. Together with Zenyth, we are growing practices strategically through proven business expertise while continually elevating the quality of patient care.

Job Type: Full-time

Pay: $60,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)