Role Summary
The RCM Specialist will play a key role in implementing and supporting the Revenue Cycle Management solution as part of the InterSystems TrakCare HIS deployment. This position requires expertise in configuring, integrating, and optimizing RCM modules to ensure accurate billing, claims processing, and compliance. The specialist will serve as the subject matter expert for revenue cycle processes, collaborating with clinical, financial, and IT teams to deliver a seamless solution.
Key Responsibilities:
- Lead the implementation of the RCM module within InterSystems TrakCare.
- Configure, test, and validate billing workflows, insurance rules, and claims processing.
- Work with integration teams to ensure seamless connectivity with HIS/EMR, finance, and third-party systems.
- Monitor HL7 and related integration messages for billing and claims transactions.
- Identify and resolve issues related to charge capture, payment posting, denials, and reconciliation.
- Train hospital billing and finance staff on system workflows and best practices.
- Coordinate with vendors, IT, and clinical teams for smooth deployment.
- Document workflows, system changes, and troubleshooting steps.
- Provide expert guidance on compliance with payer and regulatory requirements.
- Support post-go-live stabilization, issue resolution, and performance monitoring.
Required Skills:
- Strong knowledge of end-to-end RCM processes, including eligibility, authorization, coding, billing, claim submission, and remittance.
- Experience with InterSystems TrakCare or similar HIS.
- Experience with HL7, integration workflows, and troubleshooting.
- Ability to read payer rules and build them into system configuration.
- Strong analytical and problem-solving skills.
- Ability to work with RCM, finance and clinical team.
Qualifications
- Bachelor's degree in healthcare management, Information Technology, or a related field.
- Minimum 5+ years of experience in Revenue Cycle Management within a healthcare setting.
- Proven experience with HIS/EMR systems (InterSystems TrakCare preferred).
