RCM Specialist I - REMOTE

About the Client

The organization operates within the healthcare revenue cycle management sector, addressing challenges related to accurate insurance verification, claim submission, and patient service in dental and medical billing. It focuses on improving the efficiency and accuracy of revenue processing to support patient care and office operations.

About the Opportunity

The RCM SPECIALIST I role is responsible for executing front-end and mid-cycle revenue cycle management tasks, primarily focusing on insurance verification, claim submission, and providing customer service. This position contributes directly to the organization's financial health by ensuring accurate eligibility checks, timely claim processing, and a positive experience for patients and offices.

Responsibilities

• Perform assigned revenue cycle management activities following best practices and internal procedures.
• Verify insurance coverage and benefits using payer portals or phone calls.
• Enter and update insurance information accurately in the practice management system.
• Confirm eligibility, plan limitations, and coordination of benefits to ensure clean claim submission.
• Submit pre-determinations and pre-authorizations with necessary clinical attachments and follow up on their status.
• Prepare and submit claims according to payer-specific requirements.
• Review and resubmit rejected claims after identifying causes.
• Respond promptly to patient and office inquiries regarding billing, insurance, and balances.
• Assist with patient statements and follow-up on outstanding balances.
• Document all insurance verifications, authorizations, claims, and patient interactions clearly.
• Escalate issues related to claim delays, system errors, or patient concerns appropriately.
• Maintain compliance with HIPAA, payer guidelines, and internal policies.
• Participate in team meetings and training to stay updated on processes and payer changes.
• Support other revenue cycle functions to ensure smooth operations.
• Help management monitor and analyze key performance indicators such as collection rate, days in accounts receivable, and the percentage of accounts receivable over 90 days.
• Maintain professionalism in all interactions with stakeholders.

Requirements

• Experience in dental office workflows and revenue cycle functions including scheduling, registration, insurance verification, fee schedules, claim submission, coding, insurance accounts receivable follow-up, and payment posting.
• Knowledge of reimbursement and compliance procedures across all payors.
• Experience with practice management software, insurance portals, clearinghouses, insurance guidelines, banking reconciliation software.
• Proficiency in MS Office, especially Excel; strong computer literacy, math, and problem-solving skills.
• Strong interpersonal and organizational skills; ability to work independently and in teams.
• Excellent oral and written communication skills.
• Commitment to quality work, meeting deadlines, and adherence to compliance and revenue cycle SOPs.
• Organized with attention to detail and strong analytical skills.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred.