RCM Specialist II

RCM Specialist II

The RCM Specialist II is an individual contributor role on the RCM team, responsible for AR follow-up, posting payments, processing refunds and credits, and auditing accounts accurately. This role supports the full revenue cycle, helping ensure timely resolution of outstanding balances, clean financial records, and a smooth experience for both practices and patients. An ideal candidate has a strong understanding of AR processes, account research, and payer guidelines. They are detail-oriented, analytical, and confident in navigating account-level discrepancies and improving key revenue cycle metrics.

Key Responsibilities:

• Perform all assigned RCM activities in accordance with best practices and internal SOPs.
• Perform AR follow-up to resolve unpaid or underpaid claims, denials, and aged balances through appropriate action (i.e. appeals, corrections, resubmissions, etc.)
• Audit accounts to verify accurate claim submission, payment application, adjustments, and resolution of outstanding balances.
• Review and resolve credit balances; process refunds to insurance and patients in compliance with regulations and internal policies.
• Post all payments – insurance and patient – accurately and in a timely manner, including zero-dollar payments and remittance reconciliations (manual and electronic).
• Apply adjustments and write-offs appropriately based on payer contracts and internal guidelines.
• Work AR aging reports regularly to reduce days in AR and the percentage of AR over 90 days.
• Maintain clear and thorough documentation of account activities, payer interactions, and refund processing steps.
• Collaborate with internal teams (billing, front office) to ensure clean claims and quick resolution of issues.
• Maintain compliance with HIPAA, payer guidelines, and internal policies.
• Participate in team meetings to discuss performance metrics, workflow updates, and process improvements.
• Support RCM management in understanding and self-identifying contributing factors to site-specific RCM KPIs, highlighting areas of concern and areas for improvement.
• KPIs include but may not be limited to: Collection Rate, Days in AR, % AR Over 90 Days.
• Identify trends in rejections, disputes, payment delays, and denials, and escalate issues for resolution. Always seek the root cause to avoid future issues.
• Maintain respect and professionalism in all interactions with internal stakeholders, patients, payers, third parties, and others.

Essential Qualifications:

• Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process.
• Must be knowledgeable of reimbursement/compliance process and procedures with all payors.
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong excel skills).
• Strong computer literacy, Excellent Math and problem-solving skills. Data entry and 10-key by touch.
• Strong interpersonal and organizational skills. Ability to work within a team setting and as an individual contributor.
• Excellent oral and written communication skills.
• Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures.
• Organized work habits, accuracy, and proven attention to detail with strong analytical skills.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred.