RCM Specialist / Certified Professional Coder (CPC)

Core Responsibilities

• Proficient in medical software, insurance websites, and EHR systems (Elation or Candid preferred)
• Verify patient eligibility and benefits including coordination of benefits
• Identify and resolve claims processing issues, including pre-submission errors, and generate appeals or reprocess claims as needed
• Communicate effectively with patients, physicians, management, staff, and third-party representatives
• Contact insurance payers for eligibility, claims resolution, and authorization requests
• Submit medical records to insurance when needed
• Review and audit patient accounts for accuracy
• Maintain compliance with professional standards, company policies, and federal, state, and HIPAA regulations
• Manage a high volume of claims, calls, chats, and tasks while meeting productivity and quality standards
• Respond promptly to all calls, chats, and voicemails during business hours
• Maintains positive and optimistic attitude
• Ensure timely completion of daily tasks

Qualifications

• 1-2 years previous Medical Billing experience
• Certified Professional Coder or Biller (CPC / CPB) required
• Payment Posting is a plus but not required
• Must be able to work independently and rely on personal knowledge/experience for problem-solving
• Must have experience with MS Word and Google Sheets or MS Excel
• Must be detail-oriented and have excellent organizational and time management skills
• Candidates must excel at providing a high level of customer service and be able to work in a team environment
• Requires strong analytical skills and attention to detail, including writing and verbal communication skills and a professional positive attitude