RCM Operations, PreProcess Specialist

VaxCare; Orlando (FL); On-site; USD 28,000 - 41,000; Full time

Job summary

VaxCare is seeking a motivated RCM Operations, PreProcess Specialist to join our in-office Core Ops team. The role focuses on pre-submittal for claims processing, directing the workflow for claim submissions, and resolving payer rejections to ensure accepted statuses.

You will work with external payer portals to verify patient eligibility and process claims through the clearinghouse, driving timely reimbursements and process improvements.

Qualifications

• Critical thinkers who are willing to research and solve problems.
• Eagerness to learn the industry and position to grow within VaxCare.
• Aptitude and motivation.
• Proficient in Excel (Pivot Tables, Formulas and Charts).
• Good tenure of consistent experience.
• Candidates with prior Healthcare Insurance Claims experience are preferred.

Responsibilities

• Meet daily metrics related to quality and quantity of work as assigned.
• File claim corrections using web-based applications and bring claims to a final state of resolution promptly.
• Investigate what factors contribute to claims not being accepted by the clearinghouse, and make changes to achieve that.
• Collaborate with your team to create and implement enhanced collection techniques based on experience, data, and analytics

Skills

Critical thinking

Willingness to learn

Motivation

Excel (Pivot Tables/ Formulas)

Healthcare claims experience

Experience/tenure

Job description

Job Description

RCM Operations, Preprocess Specialist

Job Description

Job Title: RCM Operations, PreProcess Specialist

Position Type: Full Time

Work Setting: In Office

Department: Core Ops: RCM - PreProcess

Reports to: PreProcess Manager

FLSA: Hourly, Non-Exempt

About Vaxcare

The healthcare system is complex, presenting challenges for everyone—patients, doctors, nurses, office managers, and billers alike. At VaxCare, we aim to streamline this complexity, eliminating unnecessary costs and confusion so that practices can focus on their important work: caring for patients. Our innovative solutions include a vaccine management and LARC access platform trusted by over 20,000 active providers nationwide. This service is powered by a multidisciplinary team of dedicated professionals who lead with integrity and a relentless drive to exceed expectations, bringing clarity and efficiency to the often-overwhelming world of healthcare.

THE POSITION

Our team is passionately dedicated to maximizing RCM reimbursement opportunities with efficiency and scalability. We are seeking a motivated problem solver to join the Revenue Cycle Management Operations Team. This role plays an integral role in the claims collection cycle, providing direction and analysis on denied claims. These responsibilities help fuel our mission.

Essential Responsibilities

The PreProcess Specialist role is all about pre-submittal for claims processing. This team oversees claims submission to insurance companies and solves any internal and payer rejection errors. The goal of this team is to ensure claims are submitted accurately and in a timely manner to an accepted status. This role exposes us to the use of external payer portals to obtain patient eligibility information and process the claims accurately through our clearinghouse.

• Meet daily metrics related to quality and quantity of work as assigned
• File claim corrections using web-based applications and bring claims to a final state of resolution promptly
• Investigate what factors contribute to claims not being accepted by the clearinghouse, and make changes to achieve that.
• Collaborate with your team to create and implement enhanced collection techniques based on experience, data, and analytics

Required Experience & Qualifications

• Critical thinkers who are willing to research and solve problems.
• Eagerness to learn the industry and position to grow within VaxCare.
• Aptitude and motivation.
• Proficient in Excel (Pivot Tables, Formulas and Charts)
• Good tenure of consistent experience.
• Candidates with prior Healthcare Insurance Claims experience are preferred.

COMPETENCIES: Core to all positions at VaxCare

• Building a team culture founded on trust, collaboration, and delivery excellence
• Belief in Something Bigger than Ourselves – Capacity to derive meaning from a larger purpose
• Humility as a Posture of Learning – Burning curiosity to learn without ego
• Adaptability & Embracing Change – Nimbleness & ready to seize new opportunities

We Live (and Work) By Our Values

• Building a team culture founded on trust, collaboration, and delivery excellence
• Belief in Something Bigger than Ourselves – Capacity to derive meaning from a larger purpose
• Humility as a Posture of Learning – Burning curiosity to learn without ego
• Adaptability & Embracing Change – Nimbleness & ready to seize new opportunities

Additional “Must Haves”

• Dependability – Must be able to meet deadlines, work independently, maintain focus, & punctual
• Interpersonal Skills – Builds strong relationships & contributes to a positive work environment.
• Computer Skills – Skilled with computers, learns new tools quickly.
• Ethics – Honest, accountable, maintains confidentiality.

Other Responsibilities

• Commute to Office: Must be able to commute to and from the corporate office for each scheduled shift.
• Prolonged sitting or standing: Team members must be able to remain in a stationary position for extended periods, as much of the work involves sitting at a computer or workstation. Some hybrid or office-based roles may also require the ability to stand for portions of a shift.
• Repetitive motions: Significant use of the hands, wrists, and fingers is required for tasks like typing, using a computer mouse, and handling paperwork.
• Visual acuity: This job requires the ability to view a computer screen and read documents for extended periods.
• Communication: Team members must be able to clearly express and exchange ideas in English to effectively communicate with customers and co-workers.
• Occasional lifting: Many office-based jobs specify the ability to occasionally lift or move up to 10-20 pounds to handle supplies or equipment.

Physical Requirements/Work Environment

TASK

Continuous

Intermittent

Seldom

N/A

Regular & Reliable Attendance

X

Standing/Walking

X

Travel/Driving/Operating Vehicle

X

Sitting (desk/computer work)

X

Lifting/Lowering/Carrying (up to 20lbs)

X

Reaching/Bending/Twisting

X

Hand/Wrist Use (typing/mouse/writing)

X

In person attendance for meetings/conferences

X

Operating Mobile Equipment/Machinery

X