RCM Specialist
About the role
We are seeking a RCM Specialist to support the end-to-end revenue cycle in psychiatry and medication management within a complex Medicaid and managed-care environment. Leveraging automation tools and integrated billing systems, this role will manage complex cases, identify process improvement opportunities, and drive continuous optimization of our tools and workflows.
Responsibilities
Claim Accuracy - Improve first-pass claim acceptance by proactively ensuring correct coding and claim submissions and flagging inconsistencies. Review EOBs and denial trends to identify recurring issues and solutions. Partner with vendors to translate requirements and rules into our tools and the clinical and care teams to update necessary workflows.
Complex Patient Cases - Work closely with billing team members, senior management, and vendors to resolve claim issues. Review clinical documentation (eg SOAP notes), own CPT/ICD-10 coding, and submit claims for complex cases. Support coding corrections and resubmissions, provide clarification, and maintain reference guides when necessary.
Compliance & RCM Strategy - Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines. Monitor changes in payer policies and stay up to date on behavioral health and psychiatry guidelines to ensure optimized coding and billing practices. Partner with the credentialing and billing teams, senior management, and vendors on implementing new payer contracts and workflows.
Requirements
Advanced proficiency with ICD-10, CPT, and HCPCS coding systems. Experience working with EHR systems, clinical notes, and medical billing software required. Experience with denial resolutions, coding audits, and QA review preferred.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) strongly preferred.
Minimum of 3 years of professional experience in medical coding and billing required. Candidates with experience in behavioral health claim management experience strongly preferred, especially in complex Medicaid and managed-care systems.
Qualifications
Strong understanding of payor patterns and HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy.
Comfortable with EOBs, patterns, and payer behavior.
Exceptional accuracy and attention to detail in coding/billing and documentation.
Skills
Technical Skills: Advanced proficiency with ICD-10, CPT, and HCPCS coding systems. Experience working with EHR systems, clinical notes, and medical billing software required. Experience with denial resolutions, coding audits, and QA review preferred.
Benefits
Annual Compensation: $60,000-80,000 (full-time)
Full Health Benefits: Medical, dental, and vision
Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave
Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.
Pay
$60,000-80,000 annually
Schedule
Remote (U.S.) required; Eastern Time preferred
Equal Employment Opportunity Statement
ReKlame Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability status, protected veteran status, or any other characteristic protected by federal, state, or local law. ReKlame Health considers several factors to ensure a fair and competitive offer when evaluating compensation packages. These include the role’s scope and responsibilities, the candidate’s work experience, education, and training, and their essential skills. Internal peer equity is also examined to maintain balance within the organization. Additionally, current market conditions and overall organizational needs are crucial in shaping the final offer. Each aspect is thoughtfully reviewed before an offer is extended, ensuring a comprehensive and equitable approach.
Fraudulent Recruiting Activity Disclaimer
Please be aware of fraudulent recruiting activity carried out by individuals or organizations claiming to represent ReKlame Health. ReKlame Health does not make job offers without an interview process and will never request payment, gift cards, cryptocurrency, or personal banking information from candidates. Official recruiting communications will be sent by authorized representatives through official company email addresses. Candidates should exercise caution and report suspicious activity.