Description

Soleo Health is seeking a full-time RCM Contract Implementation Administrator to work Remotely (USA). Join us in Simplifying Complex Care!

Soleo Health Perks:

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• No Weekends or Holidays
• Paid Parental Leave Options
• Affordable Medical, Dental, & Vision Insurance Plans
• Company Paid Disability & Basic Life Insurance
• HSA & FSA (including dependent care) Options
• Education Assistance Program

The Position:

The RCM Contract Implementation Administrator supports Reimbursement Contract Management with implementation of new contracts or amendments to existing agreements via continuous education/training, Reimbursement/Intake staff support and billing audits, specifically on top contracted payor accounts. This position requires a high level of communication with internal stakeholders and collaboration with contracted payors, to provide training to internal staff and resolve reimbursement concerns. Responsibilities Include:

• Provides consultation, education and training on payor contract requirements to Patient Access and Reimbursement teams to align processes and training, to ensure clean claims and timely collections.
• Creates learning aids, SOPs, and other resource tools for staff, including state or contract specific billing/collection guidance. Manage payor-related resources on company’s intranet site.
• Develops and executes audit programs to ensure accurate medical billing compliance with federal/state/local requirements, third party contracts and government programs.
• Works with Area Reimbursement & Patient Access Managers to determine training needs and to educate staff on audit findings.
• Conducts confirmation of payor contract rate application on claims and investigates payment variances for contracted payor non-compliance.
• Works collaboratively with payors on root cause analysis findings to resolve contract related issues impacting reimbursement.
• Prepares claim-related reports for submission to payors and assists with special projects.
• Acts as a liaison between reimbursement/intake staff and assigned contracted payors regarding reimbursement related concerns.
• Provides input to help develop strategies and techniques to maximize margins and eliminate losses, including recommending changes or improvements to billing practices.
• Performs other tasks requested and supervised by the Reimbursement Contract Manager to assist with implementation of programs, policies or procedures, including identifying areas of improvement on best practices.

Schedule:

Must be able to work standard business hours Monday-Friday between the hours of 8:30am-5pm, 40 hours per week.

Requirements

• High school diploma or equivalent required, with a degree in related area preferred
• At least 5 years of experience in Home Infusion or Specialty Pharmacy medical billing, collections, bill auditing, financial root cause analysis, or closely related field
• Must have a solid understanding of Payor Contracts and reimbursement methodologies related to infusion or specialty pharmacy services
• Experience with medical infusion billing audit practices and techniques
• Experience in diagnosing, isolating and resolving complex issues and recommending/ implementing strategies to resolve issues
• Advanced knowledge of medical insurance plans: Managed Care Organizations, Commercial, Medicare Advantage, Self-Funded, TPAs and groups holding financial risk
• Advanced knowledge of Home Infusion or Medical Specialty Pharmacy pricing/fee schedules
• High level of organization required, with proficiency in the Microsoft suite of products
• Experience with developing process documentation/manuals preferred
• CPR+ experience preferred

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values:

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

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