RCM Specialist

Job Summary

Owning the end-to-end life of claims, the full-time RCM Specialist will manage payer authorizations, claim creation and submission, and the resolution of rejections and denials, ensuring a comprehensive approach to revenue cycle management.

Key Responsibilities

• Obtain and validate prior authorizations, verify member eligibility, and ensure data integrity for billing
• Prepare, review, and submit clean claims to various payers while adhering to timely filing requirements
• Analyze denials and remittance advice to determine appropriate actions, including appeals and follow-up on outstanding balances

Required Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree in a related field preferred
• 3+ years of experience in medical billing or revenue cycle management, covering both authorization and claim resolution
• Demonstrated experience with prior authorization workflows across various payer types
• Working knowledge of CPT, HCPCS, ICD-10, and medical terminology
• Proficiency in Microsoft Excel and experience with billing/EMR platforms and clearinghouse transactions