RCM Specialist I - REMOTE
About The Position
The RCM Specialist I is an individual contributor on the revenue cycle management (RCM) team, responsible for front-end and mid-cycle revenue cycle tasks, primarily insurance verification, claim submission, and customer service. The role supports accurate eligibility and benefit gathering across dental or medical payers, clean pre-authorization and claim generation, timely insurance processing, and positive experiences for patients and supported offices. The position is remote and scheduled Monday through Friday, 8 a.m. to 5 p.m. The Specialist works with patients, supported practices, payers, and internal stakeholders to verify benefits, submit and follow up on pre-authorizations and claims, respond to billing inquiries, and support collection and accounts-receivable processes. The role also helps RCM management understand factors affecting site-specific KPIs, including collection rate, days in accounts receivable, and the percentage of AR over 90 days. Work must comply with HIPAA, payer guidelines, and internal policies and procedures.
Requirements
- Prior experience with dental office workflows and revenue cycle functions, including scheduling, registration, insurance verification, fee schedules, claim submission, charging and coding requirements, insurance AR follow-up, and payment posting.
- Knowledge of reimbursement and compliance processes and procedures with payers.
- Experience with practice management software, insurance portals, clearinghouses, insurance guidelines, and banking reconciliation software.
- Intermediate PC skills, including Microsoft Office and strong Excel skills; strong computer literacy.
- Excellent math and problem-solving skills.
- Data entry and 10-key skills by touch.
- Strong interpersonal and organizational skills, with the ability to work in a team setting and as an individual contributor.
- Excellent oral and written communication skills.
- Ability to produce quality work, meet deadlines, and adhere to compliance and revenue cycle standard operating procedures.
- Organized work habits, accuracy, attention to detail, and strong analytical skills.
Nice To Haves
- Certified Professional Coder (CPC) credential.
- Certified Revenue Cycle Professional (CRCP) credential.
Responsibilities
- Perform assigned RCM activities in accordance with best practices and internal standard operating procedures.
- Verify insurance coverage and benefits for scheduled patients through payer portals or phone calls.
- Enter and update insurance information accurately in the practice management system.
- Confirm eligibility, plan limitations, and coordination of benefits so claims are submitted in the appropriate billing order.
- Submit requested pre-determinations and pre-authorizations with necessary clinical attachments, follow up on processing status, and notify practices of returned statuses promptly to avoid treatment delays.
- Prepare and submit electronic, paper, or portal-based claims according to payer-specific requirements and timelines.
- Review rejected claims, identify causes, and resubmit corrected claims as needed.
- Respond promptly and professionally to patient and office inquiries about billing, insurance coverage, and balances.
- Assist with creating and sending patient statements and following up on outstanding balances as directed.
- Document insurance verification results, pre-authorization and claim submissions, and patient interactions thoroughly and clearly.
- Escalate claim delays, system errors, and patient concerns to appropriate RCM team members or supervisors.
- Maintain compliance with HIPAA, payer guidelines, and internal policies.
- Participate in team meetings and training to stay current on processes, tools, and payer updates.
- Support other RCM functions as needed to maintain an efficient revenue cycle.
- Support RCM management in understanding and identifying factors affecting site-specific RCM KPIs, including collection rate, days in AR, and percentage of AR over 90 days.
- Monitor and report net collection rate performance against targets and collaborate on improvement opportunities.
- Track average days in AR and investigate delays or bottlenecks affecting collections, payment application, claim filing, billing, and claim resolution.
- Analyze AR over 90 days by insurance versus patient balances and work with the team to reduce aged receivables.
- Maintain respect and professionalism in interactions with internal stakeholders, patients, payers, third parties, and others.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
