RCM Specialist I
About The Position
The Revenue Cycle Management (RCM) Specialist I performs foundational revenue cycle functions including claim follow-up, denial resolution, payment review, account research, and payer communication. This role supports timely claim resolution, accurate reimbursement, and departmental workflow needs. The Specialist I demonstrates working knowledge of revenue cycle processes while maintaining productivity, accuracy, and compliance standards. This position collaborates with team members to support overall departmental operations and contributes to a high-performing revenue cycle team. The Specialist I builds core skills needed for advancement into more complex revenue cycle responsibilities.
Requirements
- High school diploma or equivalent
- Experience in revenue cycle, medical billing, accounts receivable follow-up, or denial management
- Demonstrated ability to meet productivity and quality expectations
- Strong written and verbal communication skills with payers and internal teams
- Ability to problem-solve and research account issues independently
- Strong organizational skills and attention to detail
- Ability to work independently and meet productivity expectations in a remote environment
- Ability to manage competing priorities in a fast-paced workflow
- Knowledge of revenue cycle processes including claim follow-up, denial management, and payment review
- Knowledge of basic payer rules, denial types, and insurance processes
- Knowledge of HIPAA regulations and PHI protection requirements
- Knowledge of Electronic Health Record (EHR) or billing system fundamentals
- Ability to sit and work at a computer for extended periods
- Reliable high-speed internet connection required
- Must maintain a private, secure, and HIPAA-compliant remote workspace free from interruptions
- Ability to maintain focus and productivity in a remote environment
- Must follow all Heritage remote work, HIPAA, and data security requirements
Nice To Haves
- Experience in behavioral health or community health settings
- Familiarity with Medicaid, Medicare, and commercial payers
- Experience with EHR or billing platforms such as Netsmart, Epic, or similar
- Equivalent combination of education and experience will be considered
Responsibilities
- Review and follow up on outstanding claims to ensure timely processing and reimbursement
- Research and resolve claim issues, discrepancies, and payer requests
- Submit corrected claims, appeals, or additional documentation as required
- Communicate with payers to clarify claim issues and obtain resolution
- Monitor claim status and ensure timely follow-up until payment or final determination
- Review payments for accuracy and identify incorrect adjustments
- Conduct account research to determine next steps for unresolved claims
- Document all actions clearly and accurately in the appropriate systems
- Maintain accurate documentation for all account activity
- Ensure compliance with billing regulations, payer requirements, and internal policies
- Protect PHI and follow all HIPAA standards at all times
- Save all work files to the shared R: Drive in accordance with data security requirements
- Assist with workflow needs and process updates as directed
- Support team communication and coordination
- Perform other duties as assigned consistent with this role
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What This Job Offers
Job Type
Part-time
Career Level
Entry Level
Education Level
High school or GED
