RCM Coordinator - Claims Resolution

About the role

Metrocare Services is seeking a RCM Coordinator – Claims Resolution to serve as a key financial liaison within the Revenue Cycle Management team. This position is responsible for ensuring the integrity of claim submission, payment accuracy, and denial prevention across multiple service lines including primary care, behavioral health, intellectual and developmental disability (IDD) services, early childhood intervention (ECI), applied behavior analysis (ABA) therapy, and LIDDA programs. This role requires advanced understanding of payer policy variations, reimbursement methodologies, and system workflows, and coordinates closely with clinical, compliance, and finance teams to safeguard and optimize agency revenue performance.

Responsibilities

• Prepare, review, and submit claims for primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services to Medicaid, Medicare, and commercial payers.
• Monitor claim status and ensure timely acceptance, adjudication, and payment across multiple service lines.
• Research and resolve claim denials, rejections, and underpayments specific to medical, behavioral health, and developmental disability services.
• Partner with clinical and administrative teams to ensure proper coding, documentation, and authorization for services provided.
• Maintain current knowledge of payer policies, rules, and regulatory requirements for mental health, primary care, ABA therapy, IDD, ECI, and LIDDA programs.
• Track denial and rejection trends across all service areas, identify root causes, and recommend corrective action.
• Document claim activity, correspondence, and resolution steps accurately in the billing system.
• Provide reporting and analysis to management regarding claim performance, payer trends, and process improvement opportunities.
• Collaborate with the Revenue Cycle Management team to ensure compliance and revenue integrity across all program areas.
• Perform other duties as assigned.

Qualifications

• High school diploma or GED.
• At least 5 years of experience in medical billing, claims processing, or revenue cycle management.
• Associate's degree in healthcare administration, business, or related field preferred.
• Bachelor's degree accepted in place of experience.
• Experience in billing and knowledge of Community Center Services preferred.
• Knowledge of ICD-10, CPT, HCPCS, and modifier usage preferred.
• Familiarity with Medicaid, Medicare, and commercial insurance requirements preferred.
• Certified Professional Biller (CPB), Certified Revenue Cycle Specialist (CRCS), or Certified Professional Coder (CPC) preferred.

Skills & competencies

• Conducts job responsibilities in accordance with ethical standards of conduct, state contract, appropriate professional standards, and applicable state/federal laws.
• Knowledge of claim submission, denial management, and payer-specific rules for Medicare, Medicaid, MCOs, Commercial, and other specialty payors.
• Ability to interpret payer contracts, fee schedules, and reimbursement policies.
• Proficiency with Availity, TMHP, or similar clearinghouse portals.
• Working knowledge of pivot-table reconciliation, payer remittance analytics, and denial trend dashboards.
• Analytical skills, professional acumen, business ethics, and thorough understanding of continuous improvement processes.
• Problem solving, respect for confidentiality, and excellent communication skills.
• Strong reasoning and problem-solving skills with the ability to make informed decisions in a dynamic and client-centered environment.
• Ability to calculate figures for claim reconciliation and payment posting.
• Strong attention to detail and ability to adapt to payer policy variations.
• Effective verbal and written communication skills.
• Excellent organizational skills with the ability to prioritize workflow and meet deadlines.
• Ability to manage multiple tasks and special projects simultaneously.
• Maintains a high level of professionalism, accuracy, and confidentiality.
• Computer skills: use of Word, Excel, Outlook, PowerPoint, and Internet resources.

Performance accountability metrics

• Maintain
• Ensure 95% of claims are submitted within five business days of service posting.
• Achieve average monthly collection cycle under 45 days.
• Maintain payer reconciliation accuracy above 98%.

Work location & schedule

This role is remote except for 6 weeks of onsite training and monthly meetings.

Physical demands

While performing the duties of this job, the incumbent is regularly required to talk and hear, use hands and fingers to operate a computer and telephone. Sitting, walking, and standing are frequent. Lifting up to 15 pounds is occasional, up to 25 pounds is occasional, and up to 50 pounds is occasional.

Benefits

• Medical/Dental/Vision
• Paid Time Off
• Paid Holidays
• Employee Assistance Program
• Retirement Plan, including employer matching
• Health Savings Account, including employer matching
• Professional Development allowance up to $2,000 per year
• Bilingual Stipend – 6% of the base salary
• Many other benefits