RCM Specialist - MED

The RCM Specialist is responsible for ensuring the proper management of the healthcare revenue cycle, supporting the full process of billing, payments, and collections.

Requirements

• Claims Management: Review, submit, and follow up on insurance claims; handle denials and appeals.
• Insurance Verification: Confirm coverage and obtain prior authorizations before services are provided.
• Accounts Receivable (AR): Monitor outstanding balances; work AR queues and resolve discrepancies.
• Payment Posting: Accurately record payments and denials; reconcile remittances and EOBs.
• Patient Access Support: Register patients, verify eligibility, and schedule services.
• Compliance & Documentation: Ensure compliance with HIPAA and payer regulations; maintain accurate records in EHR systems.
• Cross-Department Collaboration: Work closely with coding, billing, clinical, and front-office teams to resolve revenue cycle issues.
• Reporting & Analysis: Generate reports to monitor performance, identify trends, and support process improvement initiatives.
• Productivity & Accuracy: Meet established expectations for both productivity and quality.
• Patient Privacy: Safeguard patient information in accordance with HIPAA requirements.
• Communication: Make targeted calls when necessary to ensure efficient resolution of issues.