RCM Coordinator - Claims Resolution

Metrocare Services•Hillside, NY

7d•Hybrid

About The Position

The RCM Coordinator – Claims Resolution serves as a key financial liaison within the Revenue Cycle Management team, responsible for ensuring the integrity of claim submission, payment accuracy, and denial prevention across multiple service lines including primary care, behavioral health, intellectual and developmental disability (IDD), early childhood intervention (ECI), applied behavior analysis (ABA) therapy, and LIDDA programs. This position requires advanced understanding of payer policy variations, reimbursement methodologies, and system workflows. The role coordinates closely with clinical, compliance, and finance teams to safeguard and optimize agency revenue performance.

Requirements

High school diploma or GED
At least 5 years of experience in medical billing, claims processing, or revenue cycle management.
Knowledge of claim submission, denial management, and payer-specific rules Medicare, Medicaid, MCOs, Commercial, and other specialty payors.
Ability to interpret payer contracts, fee schedules, and reimbursement policies.
Proficiency with Availity, TMHP, or similar clearinghouse portals.
Working knowledge of pivot-table reconciliation, payer remittance analytics, and denial trend dashboards.
Conducts job responsibilities in accordance with ethical standards, state contracts, professional guidelines, and applicable state/federal laws.
Strong analytical and problem-solving skills.
Effective verbal and written communication skills.
Excellent organizational skills with the ability to prioritize workflow and meet deadlines.
Ability to manage multiple tasks and special projects simultaneously.
Maintains a high level of professionalism, accuracy, and confidentiality.
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.
Ability to calculate figures for claim reconciliation and payment posting.
Strong attention to detail and ability to adapt to payer policy variations.
Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint).
Ability to utilize Internet for resources.
Current State of Texas Driver License or if you live in another state, must be currently licensed in that state. If licensed in another state, must obtain Texas Driver License within three (3) months of employment.
Liability insurance required if employee will operate personal vehicle on Center property or for Center business.
Must be insurable by Center’s liability carrier if employee operates a Center vehicle or drives personal car on Center business.
Must have an acceptable driving record.

Nice To Haves

Associate’s degree in healthcare administration, business, or related field
Experience in billing and knowledge of Community Center Services
Knowledge of ICD-10, CPT, HCPCS, and modifier usage
Familiarity with Medicaid, Medicare, Certified Professional Biller (CPB), Certified Revenue Cycle Specialist (CRCS), or Certified Professional Coder (CPC), and commercial insurance requirements.
A bachelor's degree will be accepted in place of experience.

Responsibilities

Prepare, review, and submit claims for primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services to Medicaid, Medicare, and commercial payers.
Monitor claim status and ensure timely acceptance, adjudication, and payment across multiple service lines.
Research and resolve claim denials, rejections, and underpayments specific to medical, behavioral health, and developmental disability services.
Partner with clinical and administrative teams to ensure proper coding, documentation, and authorization for services provided.
Maintain current knowledge of payer policies, rules, and regulatory requirements for mental health, primary care, ABA therapy, IDD, ECI, and LIDDA programs.
Track denial and rejection trends across all service areas, identify root causes, and recommend corrective action.
Document claim activity, correspondence, and resolution steps accurately in the billing system.
Provide reporting and analysis to management regarding claim performance, payer trends, and process improvement opportunities.
Collaborate with the Revenue Cycle Management team to ensure compliance and revenue integrity across all program areas.
Performs other duties as assigned.