RCM Specialist II (On-Site)
About The Position
The RCM Specialist II is an individual contributor on the revenue cycle management team. The role supports the full revenue cycle by handling accounts receivable follow-up, payment posting, refunds and credits, and account audits. It helps ensure timely resolution of outstanding balances, accurate financial records, and a smooth experience for practices and patients. The ideal candidate understands AR processes, account research, and payer guidelines, and is detail-oriented, analytical, and confident resolving account-level discrepancies and improving revenue cycle metrics. The role is on-site and full-time, with a Monday–Friday schedule. The specialist works with billing and front-office teams, supports RCM management in understanding site-specific KPIs, and identifies trends and root causes affecting rejections, disputes, payment delays, and denials. The position requires compliance with HIPAA, payer guidelines, internal policies, and revenue cycle standard operating procedures.
Requirements
- Prior experience in 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 for all payors.
- Experience with practice management software, insurance portals, clearinghouses, insurance guidelines, and banking reconciliation software.
- Intermediate PC skills, including strong Microsoft Excel skills, and strong computer literacy.
- Excellent math and problem-solving skills.
- Data-entry skills and ability to use a 10-key keypad by touch.
- Strong interpersonal and organizational skills, with the ability to work both 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.
- Follow up on accounts receivable to resolve unpaid or underpaid claims, denials, and aged balances through appeals, corrections, resubmissions, or other appropriate actions.
- Audit accounts to verify accurate claim submission, payment application, adjustments, and resolution of outstanding balances.
- Review and resolve credit balances and process insurance and patient refunds in compliance with regulations and internal policies.
- Accurately and promptly post insurance and patient payments, including zero-dollar payments, and reconcile manual and electronic remittances.
- Apply adjustments and write-offs in accordance with payer contracts and internal guidelines.
- Regularly work AR aging reports to reduce days in AR and the percentage of AR over 90 days.
- Maintain clear, thorough documentation of account activities, payer interactions, and refund processing.
- Collaborate with billing and front-office teams to support clean claims and quick issue resolution.
- Comply with HIPAA, payer guidelines, and internal policies.
- Participate in team meetings on performance metrics, workflow updates, and process improvements.
- Support RCM management in understanding site-specific RCM KPIs and identifying contributing factors, concerns, and improvement opportunities.
- Monitor and report on net collection rate performance against targets and collaborate with the team on improvement opportunities.
- Track and evaluate days in AR, investigate delays or bottlenecks, and support appropriate collection, payment application, claim filing, and claim resolution.
- Review and analyze AR over 90 days, distinguish insurance and patient balances, identify trends, and help reduce aged receivables.
- Identify trends in rejections, disputes, payment delays, and denials; escalate issues and seek root causes to prevent recurrence.
- Maintain respectful and professional interactions with internal stakeholders, patients, payers, third parties, and others.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
