About GEM HEALTH:
GEM HEALTH is determined to make healthcare, and all aspects of receiving the care a patient needs, simpler for everyone. Patients deserve simple, hassle free and affordable care that works. Clinicians should focus on providing care, not administering the business of care. Insurance companies and employers should have confidence in the partners they choose; that partners are focusing on reducing costs for everyone and driving positive outcomes.
GEM HEALTH is the company and platform driving towards these ambitious goals in specialty care. Specialty care picks up where Primary Care hands off and is their partner to help diagnose, treat, and support patients at scale. GEM’s first offering, GEM SLEEP, will be the first patient focused solution that solves the most pressing problems in Sleep Apnea – one partner to help navigate the end-to-end process in an accessible and affordable manner.
Come help us build the platform that consumers truly want, but rarely expect and receive, for their health.
Role Overview:
GEM seeks an experienced Senior Manager of Revenue Cycle Management to develop and drive our RCM operations. As a key member of an early stage business you will directly impact the trajectory of the business, driving a key aspect of both financial performance and customer satisfaction. You will serve as subject matter expert and operational leader both internally and externally for RCM performance. This position reports to the Vice President of Operations.
Responsibilities:
- Develop and oversee adherence to operational processes and policies for revenue cycle management across the organization
- Drive and manage performance of RCM operations through oversight of billing and credentialing resources. Daily task areas for these resources include eligibility checks, patient cost estimates, prior authorizations, claim submission and follow up, patient and payer collections and provider credentialing. Jump in to directly perform operational tasks as needed.
- Investigate and analyze issues, patterns or trends, identifying and implementing process improvement actions within RCM function
- Establish processes for implementing new contracts in a scalable manner including storing contracted rates, medical policies and requirements.
- Maintain knowledge of existing contracts and requirements.
- Develop understanding of RCM billing tools and serve as subject matter expert on these tools.
- Periodically review company’s chargemaster and provide recommendations for modifications or enhancements.
- Establish RCM daily and monthly operational KPIs and manage performance of these KPIs
- Work with reporting team to develop RCM reporting that provides leadership visibility to claims, collections and operational metrics
- Serve as face of RCM operations to rest of the company, providing proactive resolution of customer issues and timely response to patient support team as required.
- Comfortable interfacing directly with patients on billing issues and questions if necessary.
- Collaborate across organization, including with Product team, to assist in enhancing internal patient management tools and external facing patient experience
- Proactively identify opportunities to scale or streamline processes
Required Qualifications
- 4+ years of medical billing or revenue cycle management experience
- Strong written and verbal communications skills
- Comfortable learning new technology tools
- Knowledgeable of drives of revenue cycle optimal performance and able to investigate and resolve complex claims and reimbursement challenges
- Independent thinker with proven ability to perform detailed analysis, make decisions and provide recommendations to leadership using data
- Enjoy working cross-functionally in a highly collaborative, virtual environment
Preferred Qualifications
- Customer service and/or account management experience
- Experience with billing for durable medical equipment, sleep therapies and/or remote patient monitoring programs
