Revenue Cycle Management (RCM) Specialist

The Revenue Cycle Management (RCM) Specialist ensures accurate billing and timely submission of electronic and paper claims under the direction of the Supervisor of Revenue Cycle Management.

This role involves monitoring claim status, researching and resolving denials or rejections, documenting account activities, and posting adjustments and collections. The RCM Specialist must demonstrate strong critical thinking skills and possess in-depth knowledge of Commercial, Medicaid, and Medicare eligibility requirements and contract guidelines.

Key Responsibilities:

Denial and Claims Management:

• Identify and analyze denial trends, using findings to suggest process and system improvements to prevent future issues
• Research and resolve unpaid, denied, and rejected claims, including communication with payers and submitting denials as needed
• Handle EDI transactions, including reconciliation of payer submissions, edits, and rejection reports
• Partner closely with the Insurance Verification team to identify upstream impacts on claim processing
• Collaborate effectively with team members and other departments to support organization goals and implement process improvements

Collections and Payment Resolution:

• Complete collection activities in compliance with payer guidelines and filing limits, ensuring actions are thoroughly documented
• Review posted payments and process account adjustments as appropriate

Customer Support and Continuous Improvement:

• Monitor patient accounts for non-payment, delayed payment, and billing irregularities, maintaining accurate records and taking appropriate steps for resolution
• Investigate and respond to patient billing inquiries

Competencies, Skills & Experience Required:

• A high school diploma or GED
• 3+ years of RCM experience, with a strong preference for familiarity with accounts receivable processes
• Ability to analyze claims data to spot trends and suggest mitigation strategies
• A history of working in digital or virtual health
• Use of medical billing systems (e.g., Candid Health, Healthie)
• Extensive experience in healthcare accounts receivable and collections
• Strong attention to detail with a focus on accuracy and prioritization
• Excellent oral and written communication skills across internal and external stakeholders
• Proven customer service abilities in resolving patient and payer inquiries
• Working knowledge of medical coding principles, denials, and payer-specific requirements
• Ability to thrive in a fast-paced, high-volume environment
• Commitment to adhering to HIPAA and regulatory compliance guidelines
• In-depth understanding of Medicaid, Medicare, and commercial insurance billing processes

Preferred Skills:

• A background in mental or behavioral health billing
• Fluent in Spanish
• Proficient in Microsoft Excel and Word