Revenue Cycle Management Specialist

Revenue Cycle Specialist | Revenue Cycle Management

Join our innovative team at NHOMS | MassOMS and play an essential role in the financial health of our practice as we strive to create outstanding experiences for our patients, partners, and community. By embracing our core values of innovation, compassion, accessibility, and one team, you'll be part of a team that makes a lasting impact on our organization's growth and success.

Our core values center around healing first for our patients. As a member of our team, we approach each day with compassion for both our patients and our team members. We promote innovation on every level, ensure we are accessible to one another, and work as one team.

As NHOMS | MassOMS continues to stabilize and scale, we are strengthening our Revenue Cycle Management team by adding a Revenue Cycle Specialist. Collaborating with the RCM Manager, this role adds the production capacity needed to work claims and accounts receivable at the pace our multi-site volume requires.

This position provides continuity and depth across core revenue cycle functions: reducing single-point dependency on any one team member while directly supporting the organization's goals around clean claim rates, days in A/R, denial reduction, and a transparent, respectful patient billing experience.

The Revenue Cycle Specialist is responsible for the day-to-day execution and health of the revenue cycle: verifying insurance, submitting clean claims, posting payments, reconciling deposits, working accounts receivable, and resolving patient billing questions. This is a hands-on production role that directly drives how quickly and accurately the practice is reimbursed.

The role partners closely with the RCM Manager, who provides oversight, training, and escalation support; the Specialist owns the claims and accounts assigned to them and works within established productivity, accuracy, and A/R targets. The position also collaborates with clinical and front office teams across locations to resolve account discrepancies and support a smooth patient financial experience.

We are looking for someone excited to jump into an engaging, collaborative environment, work across departments, and actively contribute to strengthening company culture, employee engagement, and mission-driven success. The ideal candidate is energized by solving problems, takes ownership of their accounts, and is motivated by clear metrics and measurable progress.

All applicants must have an understanding of accounts receivable (A/R) in a medical or dental setting. This includes detailed knowledge of insurance, submitting claims, managing and reconciling EOBs to post payments, and overall proficiency with the revenue cycle.

Primary Responsibilities

Insurance Verification & Eligibility

Verify and update patient insurance coverage, eligibility, and benefits prior to services being rendered.

Communicate coverage limitations and patient financial responsibility to the appropriate clinical and front office teams.

Claims Submission & Accuracy

Review claims for accuracy and completeness before submission, ensuring compliance with payer-specific guidelines.

Submit electronic and paper claims in a timely manner to support clean claim rate and days-to-bill targets.

Identify and correct billing and coding errors to reduce rejections and prevent avoidable denials.

Payment Posting & Reconciliation

Post insurance and patient payments to accounts accurately, reconciling EOBs and resolving discrepancies.

Reconcile EFT deposits within the bank account and escalate unresolved variances to the RCM Manager.

Balance out payments at the end of each day and complete daily payment reconciliation.

Support month-end financial reconciliation, ensuring payments and adjustments are accounted for.

Accounts Receivable Management

Review and prioritize outstanding A/R, working aged claims according to established follow-up cadence.

Contact insurance companies to follow up on unpaid, underpaid, and denied claims, and take corrective action to resolve them.

Review patient A/R and make collection calls on outstanding accounts.

Denial & Variance Resolution

Research and resolve claim denials, coding discrepancies, and payment variances.

Escalate complex, high-dollar, or systemic payer issues to the RCM Manager with supporting documentation.

Track denial reasons and surface recurring patterns that indicate an upstream process or coding issue.

Refunds & Credit Balances

Initiate and track patient and insurance refunds through completion, in accordance with organizational policy and regulatory requirements.

Review credit balances and unapplied payments for timely resolution.

Patient Financial Experience

Respond to patient inquiries regarding billing statements, treatment estimates, payment options, and insurance coverage in a professional and empathetic manner.

Collect, post, and manage patient account payments and payment arrangements.

Coordinate with other departments to resolve patient account discrepancies and insurance issues.

Billing Administration

Complete clerical revenue cycle functions including billing, treatment estimates, and monthly patient statements.

Maintain detailed and accurate documentation of all billing activities, payer communications, and account notes.

Compliance & Risk Management

Ensure compliance with HIPAA, payer requirements, and company policies regarding patient information and billing procedures.

Audit assigned patient accounts for accurate billing, coding, and payment posting.

Stay current on changes to insurance policies, billing regulations, and compliance requirements.

Reporting & Data

Assist in the preparation of reports on claim status, payments received, and outstanding balances.

Provide accurate account-level detail to support the RCM Manager's reporting on revenue performance and KPIs.

Team Support & Continuous Improvement

Assist other staff with billing and coding-related questions, and support training of new team members on billing processes and software as needed.

Participate in team meetings to review revenue cycle performance, surface trends and obstacles, and contribute to process improvements.

Minimum Requirements

Medical or dental billing experience: 1 year (required).

Demonstrated understanding of accounts receivable, insurance claim submission, and EOB reconciliation in a healthcare setting.

Strong communication, problem-solving, computer, phone, and analytical skills.

Ability to work efficiently within dental or medical practice management software systems.

Proficiency in Microsoft Office, including Excel and Word.

Strong attention to detail and comfort working with numbers and reconciliation.

Efficient time-management and prioritization skills, with the ability to work independently in a fast-changing environment.

Knowledge of laws and policies related to debt collection, and the judgment to apply them with professionalism.

Preferred Experience and Qualifications

Bachelor's degree in Accounting, Finance, or a relevant field, or commensurate experience.

Dental, oral surgery, or related experience: 1 year.

Open Dental experience.

Multi-site or multi-state payer experience.

Experience with insurance follow-up and A/R management in a healthcare setting.

Working knowledge of medical, dental, and oral surgery terminology.

Familiarity with data collection and reporting, and presenting account or payer trends to leadership.

How Performance Is Measured

In partnership with the RCM Manager, performance in this role is reviewed against clear, measurable standards, including:

Clean claim rate and first-pass acceptance on submitted claims

Days in A/R and aged A/R reduction for assigned payers or account segments

Denial rate and denial turnaround time how quickly denials are worked and resolved

Payment posting accuracy and timely completion of end-of-day balancing

Collections performance against monthly targets

Documentation quality and audit results on assigned accounts

Patient billing inquiry responsiveness and resolution

12-Month Success Profile

Our goal for the individual filling this role is for full transparency into how we define success for this role and what we aim to help them achieve. Currently, our roadmap generally follows this structure:

By 90 Days:

Become proficient in our practice management software, payer portals, and clearinghouse workflows.

Independently verify eligibility, submit clean claims, and post insurance and patient payments.

Complete daily payment reconciliation and end-of-day balancing without oversight.

Work an assigned A/R follow-up queue