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