RCM Specialist II - REMOTE

About Our Client

The organization operates within the dental healthcare revenue cycle management sector. It addresses challenges related to managing accounts receivable, claims processing, and payment accuracy to ensure financial integrity and smooth patient and practice experiences. The company focuses on optimizing revenue cycle processes to reduce outstanding balances and improve key financial metrics.

About the Opportunity

The RCM Specialist II is a remote individual contributor role focused on managing accounts receivable activities within the revenue cycle management team. This position is responsible for ensuring accurate payment posting, resolving unpaid or underpaid claims, auditing accounts, and maintaining compliance. The role is critical to maintaining clean financial records and supporting efficient revenue cycle operations.

Responsibilities

• Perform assigned revenue cycle management activities according to best practices and internal procedures.
• Follow up on accounts receivable to resolve unpaid or underpaid claims, denials, and aged balances through appeals, corrections, or resubmissions.
• Audit accounts to confirm accurate claim submission, payment application, adjustments, and resolution of outstanding balances.
• Review and resolve credit balances; process refunds to insurance and patients in compliance with regulations and policies.
• Post all payments accurately and timely, including insurance and patient payments, zero-dollar payments, and remittance reconciliations.
• Apply adjustments and write-offs based on payer contracts and internal guidelines.
• Regularly monitor aging reports to reduce days in accounts receivable and the percentage of accounts over 90 days.
• Maintain detailed documentation of account activities, payer interactions, and refund processing.
• Collaborate with internal teams to ensure clean claims and prompt issue resolution.
• Ensure compliance with HIPAA, payer guidelines, and internal policies.
• Participate in team meetings to review performance metrics and support process improvements.
• Assist management in analyzing site-specific revenue cycle KPIs and identifying areas for improvement.
• Monitor collection rate, days in accounts receivable, and percentage of accounts over 90 days, investigating and addressing issues.
• Identify and escalate trends in rejections, disputes, payment delays, and denials.
• Maintain professionalism in interactions with internal stakeholders, patients, payers, and third parties.

Requirements

• Experience with dental office workflows and revenue cycle functions including scheduling, registration, insurance verification, fee schedules, claim submission, coding, payment posting, and accounts receivable follow-up.
• Knowledge of reimbursement and compliance processes across various payers.
• Proficiency with practice management software, insurance portals, clearinghouses, banking reconciliation software, and intermediate MS Office skills, especially Excel.
• Strong computer literacy, math, problem-solving, data entry, and 10-key skills.
• Strong interpersonal, organizational, and communication skills.
• Ability to work independently and within a team.
• Commitment to quality work, meeting deadlines, and adherence to compliance and revenue cycle procedures.
• Attention to detail and strong analytical skills.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred.

Pay Range and Compensation Package

The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.