RCM Specialist

Job Summary

To support the end-to-end revenue cycle in psychiatry and medication management, the full-time remote RCM Specialist will manage complex cases, ensure accurate coding and claim submissions, and drive process improvements within a Medicaid and managed-care environment.

Key Responsibilities

• Improve first-pass claim acceptance by ensuring correct coding and submissions, while identifying and resolving denial trends
• Collaborate with billing team members and vendors to manage complex patient cases, including reviewing clinical documentation and submitting claims
• Ensure compliance with CMS, state Medicaid, and managed-care guidelines, while monitoring payer policy changes and optimizing coding practices

Required Qualifications

• Minimum of 3 years of professional experience in medical coding and billing, with a preference for behavioral health claim management experience
• Advanced proficiency with ICD-10, CPT, and HCPCS coding systems, along with experience in EHR systems and medical billing software
• Strong understanding of payer patterns and healthcare compliance guidelines, including HIPAA
• Analytical mindset with problem-solving expertise in addressing complex challenges and implementing improvements
• Exceptional accuracy and attention to detail in coding, billing, and documentation processes