RCM COORDINATOR

Position Summary

The Revenue Cycle Coordinator is responsible for overseeing and executing advanced billing and collections processes to ensure timely reimbursement and resolution of outstanding claims. This role requires in-depth knowledge of payer guidelines, denial management, and AR follow-up strategies.

Key Responsibilities

• Serve as a liaison for vendors and providers to address billing, payment, and operational issues
• Perform Time of Service (TOS) bank reconciliation and assist with end-of-day (EOD) balancing processes
• Review credit balances to ensure no errors in overpayments or underpayments, and timely processing
• Lead unapplied payment reviews, moving money as appropriate, or initiating a refund back to the patient
• Assist with work down of claim inventory in legacy systems, ensuring timely resolution and clean-up of aged AR
• Conduct payer policy research to support claim resolution, appeals, and process improvements
• Manage and resolve escalated patient billing inquiries, ensuring timely and accurate resolution
• Support special projects and ad hoc reporting as assigned, including investigating and resolving complex billing issues, including denials, rejections, and payer discrepancies
• Submit corrected claims, appeals, and reconsiderations with appropriate documentation as requested or as associated with assigned special projects.
• Work closely with vendors to resolve complex billing issues
• Identify patterns in denials and collaborate with internal teams (coding, front desk, authorizations) to prevent future issues
• Ensure compliance with payer regulations, billing guidelines, and company policies

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred
• 3–5+ years of medical billing and AR follow-up experience (specialty experience preferred, if applicable)
• Strong knowledge of CPT, ICD-10, and HCPCS coding (coding certification a plus)
• Experience working with multiple payer types including Medicare, Medicaid, and commercial insurance
• Exposure to payment posting and charge entry
• Proficiency in EHR/PM systems (e.g., eClinicalWorks, NextGen, Athena, etc.)
• Strong understanding of denial codes (CARC/RARC) and appeals processes
• Intermediate Excel including creating pivot tables

Key Competencies

• Detail-oriented with strong organizational skills
• Critical thinking and root cause analysis
• Effective communication with internal and external stakeholders (vendors, providers, payers)
• Forward-thinking with a proactive approach to process improvement

Performance Metrics

• AR days and aging benchmarks
• Denial resolution rate
• Clean claim rate improvement
• Timely filing compliance
• Appeals success rate
• Accuracy of TOS and EOD reconciliation processes
• Legacy AR reduction and inventory resolution

Work Environment

• Local candidates only
• May require extended screen time and high-volume data entry.