RCM Operations, PreProcess Specialist

PreProcess Specialist

JOB DESCRIPTION

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
• Collaborate with your team to create and implement enhanced collection techniques based on experience, data, and analytics
• Primarily, this role works with payers to understand why a claim was denied. Team members in this role also call to get the claim status, which may be paid. In that case, team members would be posting payments to our data entry portal

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.
• *Bonus* Candidates with prior Healthcare Insurance Claims experience.

OTHER ESSENTIAL REQUIREMENTS 

• Prolonged sitting or standing: Employees 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: The job requires the ability to view a computer screen and read documents for extended periods. 
• Communication: Employees 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.