RCM Specialist I

Revenue Cycle Management Specialist I 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. Leadership & Team Expectations: Model professionalism and accountability in all interactions Communicate clearly and respectfully with payers, team members, and supervisors Collaborate effectively to resolve account issues and support team workflows Uphold Heritage's mission and values in all work performed Demonstrate reliability by consistently meeting productivity, quality, and attendance expectations Engage in learning and skill development to support growth within the department Core Responsibilities Include: Claim Follow-Up & Resolution: 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 Payment Review & Account Research: 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 Documentation & Compliance: 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 Team Support & Workflow: Assist with workflow needs and process updates as directed Support team communication and coordination Perform other duties as assigned consistent with this role Performance Expectations / What Success Looks Like: Claims are followed up on promptly and resolved efficiently Documentation is accurate, complete, and timely across all accounts Denials are reduced through effective follow-up and corrective action Team members view this person as reliable and communicative Productivity and quality standards are consistently met or exceeded Remote work expectations are consistently met, including responsiveness, workspace compliance, and availability Knowledge, Skills and Abilities: Knowledge of: Revenue cycle processes including claim follow-up, denial management, and payment review Basic payer rules, denial types, and insurance processes HIPAA regulations and PHI protection requirements Electronic health record (EHR) or billing system fundamentals Skills and Abilities: 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 Education and Experience: Required: 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 Preferred: 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 Note: Equivalent combination of education and experience will be considered. Physical Requirements and Working Conditions: 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