RCM Specialist

Reklame Health

2d • $60,000 - $80,000 • Remote

About The Position

ReKlame Health is seeking an RCM Specialist to manage the end-to-end revenue cycle for psychiatry and medication management services, particularly within complex Medicaid and managed-care environments. This role will utilize automation tools and integrated billing systems to handle complex cases, identify areas for process improvement, and continuously optimize tools and workflows. The RCM Specialist will collaborate with the Billing Specialist and vendor team to ensure accurate coding, sufficient documentation for billed services, and early detection of denial risks. This position is well-suited for an individual with at least three years of experience in behavioral health RCM, who possesses strong skills in detail-oriented work, pattern recognition, and improving claim quality.

Requirements

• Minimum of 3 years of professional experience in medical coding and billing required.
• Advanced proficiency with ICD-10, CPT, and HCPCS coding systems.
• Experience working with EHR systems, clinical notes, and medical billing software required.
• Strong understanding of payor patterns and HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
• Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy.
• Must be comfortable with EOBs, patterns, and payer behavior.
• Exceptional accuracy and attention to detail in coding/billing and documentation.
• Remote (U.S.) required; Eastern Time preferred.

Nice To Haves

• Experience with denial resolutions, coding audits, and QA review preferred.
• Candidates with experience in behavioral health claim management experience strongly preferred, especially in complex Medicaid and managed-care systems.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) strongly preferred.

Responsibilities

• Improve first-pass claim acceptance by proactively ensuring correct coding and claim submissions and flagging inconsistencies.
• Review EOBs and denial trends to identify recurring issues and solutions.
• Partner with vendors to translate requirements and rules into our tools and the clinical and care teams to update necessary workflows.
• Work closely with billing team members, senior management, and vendors to resolve claim issues.
• Review clinical documentation (eg SOAP notes), own CPT/ICD-10 coding, and submit claims for complex cases.
• Support coding corrections and resubmissions, provide clarification, and maintain reference guides when necessary.
• Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines.
• Monitor changes in payer policies and stay up to date on behavioral health and psychiatry guidelines to ensure optimized coding and billing practices.
• Partner with the credentialing and billing teams, senior management, and vendors on implementing new payer contracts and workflows.

Benefits

• Full Health Benefits: Medical, dental, and vision
• Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave.
• Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed