RCM Specialist I

Job Title: Revenue Cycle Management Specialist I

Reports to: Revenue Cycle Manager

Accountable to: Senior Director of Revenue Cycle Management

Schedule: Monday–Friday, standard business hours

FLSA Status: Non-Exempt

Position Type: Part-Time

Work Setting: Remote

Position Overview: 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.

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: The Revenue Cycle Management Specialist I will be successful in this role when:

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

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