RCM Specialist III

Nephrology Associates Medical Group • Riverside, CA

4d

About The Position

A Revenue Cycle Specialist III (RCS III) acts as a senior-level expert in medical billing and collections, managing complex denials, insurance appeals, and high-dollar accounts to optimize cash flow. They frequently serve as subject matter experts (SMEs) supporting staff, auditing billing accuracy, and analyzing payer trends to ensure regulatory compliance and maximize reimbursement.

Requirements

• Expertise in medical billing and collections.
• Experience managing complex denials and insurance appeals.
• Experience with high-dollar accounts.
• Proficiency in EMR/practice management systems (e.g., Athena, Epic, Allscripts).
• Knowledge of ICD-10/CPT coding guidelines.
• Understanding of payer contracts and regulatory compliance.

Nice To Haves

• Subject matter expert (SME) capabilities.
• Experience auditing billing accuracy.
• Experience analyzing payer trends.
• Experience in training and supporting junior staff.
• Experience recommending process improvements.

Responsibilities

• Reviewing and resolving complicated, denied, or slow-pay claims by analyzing EOBs (Explanation of Benefits) and crafting detailed written appeals.
• Researching and resolving aged, high-risk, or high-dollar accounts to ensure maximum reimbursement.
• Utilizing EMR/practice management systems (e.g., Athena, Epic, Allscripts) to run, analyze, and report on key performance indicators (KPIs) to leadership.
• Acting as a technical resource for junior staff, assisting in training, and providing cross-training in complex multi-specialty billing areas.
• Monitoring payer contracts and coding guidelines (ICD-10/CPT) to ensure compliance, while recommending process improvements for faster charge capture.

What This Job Offers

• Career Level: Senior
• Education Level: No Education Listed