Revenue Cycle Management Specialist

Fgcplus; Davao del Sur; On-site; PHP 446,000 - 781,000; Full time

Benefits offered by this job

Day 1 HMO

Competitive pay with incentives

13th month pay

Onsite medical support

Employee Engagement Events

Employee Referral Program

Skills training for development

Job summary

FGC+ is seeking an RCM Operations Specialist to ensure accurate payer configurations in the system and promptly resolve billing issues across commercial insurers, Medicare, Medicaid, and other payers. You will collaborate with billing and coding teams to fix errors and ensure seamless claim processing.

Responsibilities include setting up payer portals, reflecting contracts in billing, managing denials, and following up with denial management teams to optimize reimbursements while maintaining

Qualifications

• 2+ years of healthcare experience.
• Proficient in EHR systems.
• Experience with insurance portals such as Availity, Medicare, CoverMyMeds, and Optum.
• Experience with benefit verification and prior authorizations.
• Detail-oriented with accurate documentation.
• Excellent written and verbal communication.
• Knowledge of medical terminology.

Responsibilities

• Set up payer configurations accurately in the RCM system.
• Resolve billing issues related to payer contracts, claims submission, and payments.
• Work with billing and coding teams to correct billing errors.
• Ensure payer contracts reflect in the billing system, including terms and rates.
• Follow up on denials and rejections due to payer configuration errors.

Skills

Healthcare experience

EHR systems

Insurance portals

Benefit verification

Documentation

Communication skills

Medical terminology

Tools

Availity

Medicare

CoverMyMeds

Optum

Job description

About FGC+

Since 2011, FGC+ has been committed to transforming US businesses through our all-inclusive outsourcing solutions. Through the years, we've built strong remote teams, developed customized processes, and provided exceptional customer service, helping companies soar to new heights. Our dedicated professionals excel in supporting a diverse range of industries with unmatched dedication.

#SparkSuccess at FGC+!

Driven by our core values of Empathy, Reliability, Possibility, and Growth, we are focused on #IgnitingPossibility and helping each team member unlock their full potential. At FGC+, we offer more than just a job; we provide a nurturing environment where work-life balance, mentorship, employee engagement, and continuous learning are the pillars of your success.

Here, you are more than just an employee—you are part of a team where you can truly thrive and make a difference.

About the Job:

The RCM Operations Specialist is responsible for ensuring that all payer configurations are accurately established in the system and that any billing issues related to payer contracts, claims submission, and payment processes are promptly resolved. This role ensures that the organization is properly set up to receive reimbursements from all payers, including commercial insurers, Medicare, Medicaid, and other third-party payers. The role also involves working closely with the billing and coding teams to correct any billing errors and ensure seamless claim processing.

What You'll Do:

1. Payer Setup and Configuration: Accurately set up and maintain payer information within the RCM system, ensuring all insurance contracts and fee schedules are correctly entered
2. Portal Setup: Ability to set up payer portals and provide privileges to the right teams
3. Contract Management: Ensure that payer contracts are correctly reflected in the billing system, including payment terms, coding rules, and reimbursement rates
4. Billing Issue Resolution: Identify and resolve any issues related to payer billing setup, provider credentialing, coding, claims rejections, underpayments, or denials due to payer configuration errors
5. Denial and Rejection Follow-Up: Work with denial management teams to address rejected claims related to payer configuration, and correct errors that prevent claims from being processed

What You'll Bring:

• 2+ years of healthcare experience required
• Great time management and prioritization skills, ability to juggle multiple referrals at once
• Experience utilizing Electronic Health Records (EHR) systems
• Experience using insurance portals (Availity, Medicare, CoverMyMeds, Optum, etc)
• Experience doing benefit verification and submitting authorizations
• Detail oriented in documentation
• Excellent communication skills (written and verbal)
• Medical terminology experience

What we have to offer:

• A company culture based on our purpose to bring out the untapped potential, creativity, and success in people, partnerships, and brands.
• A culture built on the mission to develop high-functioning teams by providing an environment of constructive support and inspiration where people grow personally and professionally
• A market competitive total compensation/rewards package including:

• Day 1 HMO
• Competitive pay including incentives and generous allowances
• Payment of all statutory government benefits
• 25 days of annual paid leave some days are convertible to cash
• 13th month pay
• Onsite medical support
• Employee Engagement Events
• Employee Referral Program
• Skills, training for personal and professional development

A million possibilities are waiting to be ignited.