RCM Coordinator – Billing & Payor Relations

Metrocare Services•Hillside, NY

6d•Hybrid

About The Position

GENERAL DESCRIPTION: The mission of Metrocare Services is to serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. We are an agency committed to quality gender-responsive, trauma-informed care to individuals experiencing serious mental illness, development disabilities, and co-occurring disorders. Metrocare programs focus on the issues that matter most in the lives of the children, families and adults we serve. The RCM Coordinator – Billing & Payor Relations plays a vital role in the financial health of the organization by ensuring accurate and timely submission of claims to Medicaid, Medicare, and commercial payors. This position supports the revenue cycle by managing billing workflows, resolving claim issues, and maintaining compliance with payer-specific requirements. The coordinator works across multiple service lines including behavioral health, primary care, IDD, ABA therapy, and other specialized programs.

Requirements

High school diploma or GED; at least 5 years of experience in medical billing, claims processing, or revenue cycle management.
Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills.
Working knowledge of 837/835 transaction files and clearinghouse operations.
Experience with denial management platforms or analytics dashboards (e.g., Waystar, Availity, Change Healthcare).
Ability to translate complex reimbursement data into actionable insights for leadership.
Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills.
Strong understanding of medical billing and claims processing for Medicaid, Medicare, and commercial payors.
Knowledge of ICD-10, CPT, HCPCS codes, and modifier usage.
Analytical and problem-solving skills with attention to detail.
Effective verbal and written communication skills.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
High level of professionalism, accuracy, and confidentiality.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and billing software systems.
Basic math skills required.
Ability to work with reports and numbers & Ability to calculate moderately complex figures and amounts to accurately report activities and budgets.
Ability to apply common sense understanding to carry out simple one or two-step instructions.
Strong reasoning and problem-solving skills with the ability to make informed decisions in a dynamic and client-centered environment.
Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint).
Ability to utilize Internet for resources.

Nice To Haves

Associate’s degree in healthcare administration, business, or related field; experience in billing wand knowledge of Community Center Services; knowledge of ICD-10, CPT, HCPCS, and modifier usage; familiarity with Medicaid, Medicare, and commercial insurance requirements.
A bachelor's degree will be accepted in place of experience.

Responsibilities

Prepare and submit clean claims to government and commercial payors for all service lines.
Monitor claim status and follow up on unpaid or rejected claims to ensure timely resolution.
Analyze and resolve denials, rejections, and underpayments by coordinating with internal departments and payors.
Ensure proper coding, documentation, and authorization are in place prior to claim submission.
Maintain up-to-date knowledge of payer guidelines, billing regulations, and reimbursement policies.
Track and report denial trends, identify root causes, and recommend process improvements.
Document all billing activities, correspondence, and resolution steps in the billing system.
Provide regular reporting to management on claim performance and payer behavior.
Collaborate with RCM team members to ensure revenue integrity and compliance.
Performs other duties as assigned.