RCM Specialist III
$50,000–$57,000 year
RemoteUnited States
Job Summary
Analyze complex accounts receivable trends, denials, and claim rejections to identify root causes and implement corrective actions. Collaborate with payers and internal stakeholders to resolve escalated billing and reimbursement issues while leading maintenance and optimization of Practice Management billing support files, fee schedules, and insurance plans. Serve as a subject matter expert by providing training, guidance, and issue resolution support to team members. Develop, test, and implement system workflows, process improvements, and best practices in partnership with leadership. Support advanced reporting, analytics, and quality assurance activities related to financial, encounter, billing, and performance metrics. Monitor payer updates, regulatory changes, and software enhancements to ensure compliance and operational readiness. Participate in special projects and perform additional duties as assigned to support organizational goals.
Required Qualifications
- Minimum of 5 years of progressive experience in revenue cycle operations, including advanced billing, collections, reimbursement, and denial management
- Expert knowledge of revenue cycle processes, payer regulations, reimbursement methodologies, and claims management
- Experience with POMIS or similar Practice Management (PM) systems
- Familiarity with Electronic Data Interchange (EDI) tools and revenue cycle reporting platforms
- Strong analytical, problem-solving, and decision-making skills
- Excellent written, verbal, and interpersonal communication skills
- Demonstrated ability to manage multiple priorities while maintaining accuracy and attention to detail in a fast-paced environment
Desired Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Finance, Business Administration, or a related field preferred
- Experience supporting multi-site healthcare organizations, Federally Qualified Health Centers (FQHCs), or physician practice groups
- Advanced experience with revenue cycle analytics and performance reporting
- Knowledge of healthcare compliance requirements related to billing and reimbursement
- Experience leading process improvement initiatives and workflow optimization projects
- Prior experience training, mentoring, or supervising revenue cycle team members
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