RCM Lead - Front End - Remote

Summary
Under the direction of the RCM Supervisor - Front End and/or Revenue Cycle leadership, the RCM Lead - Front End supports the daily front-end revenue cycle operations for Optim Orthopedics. This role serves as a working lead for patient access, insurance verification, financial clearance, scheduling/check-out support, point-of-service collections, and front-end workflow resolution. The RCM Lead helps monitor daily work queues, supports staff training, escalates workflow barriers, and promotes accurate, timely, and patient-centered service.

Essential Duties and Responsibilities

Front-end Revenue Cycle Operations

Support daily patient access operations, insurance verification, authorizations for surgery/MRI/therapy, claim creation support, scheduling/check-out workflows, and point-of-service collections.

Ensure accurate and complete patient demographic and insurance data entry to reduce claim denials.

Assist authorization and surgery coordination teams with financial clearance follow-up to help ensure established timelines are met.

Support staff in resolving real-time patient issues related to scheduling, insurance, or financial responsibility.

Support patient and insurance refund workflows by ensuring items are routed according to established workflow and compliance expectations.

Provide in person or virtual coverage during staffing gaps, high volume periods, or training transitions.

Revenue Cycle Responsibilities

Identify eligibility issues, authorization gaps, denial trends, and payer issues; escalate trends and recommended solutions to the RCM Supervisor and appropriate team members.

Support front desk and billing staff in resolving patient billing inquiries and claim concerns.

Assist with accuracy of receipt processing, reconciliation support, and monthly or yearly closing activities as directed by leadership.

Ensure compliance with policies, procedures, and regulatory guidelines across all patient access and revenue operations.

Participate in continuous improvement initiatives, including workflow enhancements and system upgrades.

Prepare or assist with weekly productivity, performance, and workflow status reports for supervisor review.

Any other duties as assigned

Must have flexibility with hours as needed for clinic. 

Follows proper security procedures at the close of each day to ensure facility safety

Other duties as assigned. 
 

Supervisory Responsibilities

This position has lead responsibilities but does not have formal supervisory authority unless delegated by leadership.

Provide day-to-day workflow guidance, coaching, and training support for front-end and RCM staff to promote productivity, professionalism, and adherence to standard workflows.

Serve as a resource between RCM leadership and front-end staff by escalating issues timely and supporting follow-through on resolutions.

Monitor daily production, work queues, and patient volume indicators; escalate workflow delays, staffing barriers, or anomalies.

Assist with training, onboarding, and support for new recruits and trainees.

Assist leadership with front desk and RCM staff coverage plans to help ensure adequate coverage at all locations.

Act as a point of contact for workflow questions and immediate escalations in the absence of the RCM Supervisor or department leadership.

Competencies 
 To perform the job successfully, an individual should demonstrate the following competencies: 

Customer Service - Works well with patients, vendors, and physicians by keeping them informed and promoting a positive image of the company at all times. Exhibits good listening and comprehension; Selects and uses appropriate communication methods. Makes eye contact with the patients as they check in and should not use cell phone at the front desk at any time when patients are present. Looks for ways to improve and promote quality patient care. 

Teamwork - Accountable to team and departmental goals, works to meet established deliverables, balances team and individual responsibilities, gives and welcomes feedback, puts success of team above own interests. Communicates with team regarding overall patient care including using resources efficiently working toward a positive patient experience. Understand the responsibilities of their work and how the flow of the front office affects the overall flow of the entire clinic.

Organizational Support - Follows policies and procedures, completes administrative tasks correctly and on time; supports organization’s goals and values. Adheres to all policies and procedures while maintaining patient confidentiality according to HIPAA guidelines. 

Dependability - Adheres to the company’s time and attendance policy. Is punctual, good attendance record, minimal to no missed punches, works independently with little to no supervision, self-starter, adheres to departmental and companywide time lines, maintains focus. 

Compliance – Adheres to all company compliance policies.

Productivity - Prioritizes and plans wok activities to ensure the completion of daily tasks. Uses time efficiently, plans for additional resources, sets personal goals and objectives to meet departmental goals. 

Job Knowledge - Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; Keeps abreast of current procedures and/or industry changes that may affect the department and/or patient service. 

Qualifications 
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High school diploma or general education degree (GED). An associate degree or certificate in medical office administration preferred. 
 Minimum of 2 years of experience in medical billing, front-end revenue cycle, collections, or accounts receivable. Prior lead or training experience preferred. 

Minimum of 2 years of experience with insurance verification, patient access workflows, or financial clearance. Experience with Athena Health or similar practice management systems is preferred. 

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Ability to sort and file materials correctly by alphabetic and numeric systems.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, and percentages.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with standardized situations with only occasional or no variables.

Computer Skills

To perform this job successfully, an individual should have knowledge of Electronic Medical Records (EMR) preferably Athena Database software; Outlook and MS Word Processing software. Skills in operating in computers, copying, scanning and faxing preferred.
 
Certificates, Licenses, Registrations 

None

Physical Demands 
 The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands regularly; and to talk or hear. The employee is required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision.
 
 May be required to travel to one or more satellite locations depending on staffing changes. May be required to participate in educational courses that correspond with current systems or functionalities.

Work Environment
 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.