Paradigm Oral Health · 15 hours ago
RCM Specialist II
Lincoln, Nebraska
Full-time
Onsite
Mid LevelParadigm Oral Health is seeking an RCM Specialist II to join their Revenue Cycle Management team. This role involves managing accounts receivable processes, ensuring timely resolution of outstanding balances, and maintaining clean financial records for practices and patients.
DentalHealth CareHospitalHospitalityMedical
Responsibilities
Perform all assigned RCM activities in accordance with best practices and internal SOPs
Perform AR follow-up to resolve unpaid or underpaid claims, denials, and aged balances through appropriate action (i.e. appeals, corrections, resubmissions, etc.)
Audit accounts to verify accurate claim submission, payment application, adjustments, and resolution of outstanding balances
Review and resolve credit balances, process refunds to insurance and patients in compliance with regulations and internal policies
Post all payments – insurance and patient – accurately and in a timely manner, including zero-dollar payments and remittance reconciliations (manual and electronic)
Apply adjustments and write-offs appropriately based on payer contracts and internal guidelines
Work AR aging reports regularly to reduce days in AR and the percentage of AR over 90 days
Maintain clear and thorough documentation of account activities, payer interactions, and refund processing steps
Collaborate with internal teams (billing, front office) to ensure clean claims and quick resolution of issues
Maintain compliance with HIPAA, payer guidelines, and internal policies
Participate in team meetings to discuss performance metrics, workflow updates, and process improvements
Support RCM management in understanding and self-identifying contributing factors to site-specific RCM KPIs, highlighting areas of concern and areas for improvement
Collection Rate: Monitor and report on the net collection rate, analyzing performance against targets. Collaborate with the team to identify opportunities for improvement
Days in AR: Track and evaluate average days in AR to ensure appropriate advanced collection, payment application, efficient and accurate claim filing, and timely back-end billing and claim resolution. Investigate and address any delays or bottlenecks that may be causing extended days in AR
% AR Over 90 Days: Review and analyze the percentage of AR over 90 days (insurance v. patient) to identify trends or issues requiring attention. Work with the team to reduce the percentage of aged receivables by implementing strategies to resolve outstanding claims and payments
Identify trends in rejections, disputes, payment delays, and denials, and escalate issues for resolution. Always seek the root cause to avoid future issues
Maintain respect and professionalism in all interactions with internal stakeholders, patients, payers, third parties, and others
Qualification
Required
Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process
Must be knowledgeable of reimbursement/compliance process and procedures with all payors
Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong excel skills). Strong computer literacy, Excellent Math and problem-solving skills. Data entry and 10-key by touch
Strong interpersonal and organizational skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skills
Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures
Organized work habits, accuracy, and proven attention to detail with strong analytical skills
Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures
Preferred
Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred
Company
Paradigm Oral Health
Paradigm Oral Health is dedicated to providing clinically excellent, patient focused oral health care with exceptional outcomes.
Founded in 2019
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknownKey Investors
Varagon Capital Partners
2022-09-22Acquired
2021-07-14Debt Financing
Leadership Team
David Rallis
Chief Executive Officer
Karley Krcilek, SHRM-SCP
Chief People Officer
Company data provided by crunchbase