RCM Specialist

Role Description

We are seeking a RCM Specialist to support the end-to-end revenue cycle in psychiatry and medication management within a complex Medicaid and managed-care environment. Leveraging automation tools and integrated billing systems, this role will manage complex cases, identify process improvement opportunities, and drive continuous optimization of our tools and workflows.

You will partner with our Billing Specialist and vendor team to ensure services are coded correctly, documentation supports billed services, and common denial risks are caught early. This role is ideal for someone with at least 3 years of behavioral health RCM experience who enjoys detail-oriented work, pattern recognition, and improving claim quality.

Key Responsibilities

• Claim Accuracy
  • Improve first-pass claim acceptance by proactively ensuring correct coding and claim submissions and flagging inconsistencies.
  • Review EOBs and denial trends to identify recurring issues and solutions.
  • Partner with vendors to translate requirements and rules into our tools and the clinical and care teams to update necessary workflows.
• Complex Patient Cases
  • Work closely with billing team members, senior management, and vendors to resolve claim issues.
  • Review clinical documentation (eg SOAP notes), own CPT/ICD-10 coding, and submit claims for complex cases.
  • Support coding corrections and resubmissions, provide clarification, and maintain reference guides when necessary.
• Compliance & RCM Strategy
  • Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines.
  • Monitor changes in payer policies and stay up to date on behavioral health and psychiatry guidelines to ensure optimized coding and billing practices.
  • Partner with the credentialing and billing teams, senior management, and vendors on implementing new payer contracts and workflows.

Qualifications

• Advanced proficiency with ICD-10, CPT, and HCPCS coding systems.
• Experience working with EHR systems, clinical notes, and medical billing software required.
• Experience with denial resolutions, coding audits, and QA review preferred.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) strongly preferred.
• Minimum of 3 years of professional experience in medical coding and billing required.
• Candidates with experience in behavioral health claim management experience strongly preferred, especially in complex Medicaid and managed-care systems.
• Strong understanding of payor patterns and HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
• Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy.
• Exceptional accuracy and attention to detail in coding/billing and documentation.

Requirements

• Remote (U.S.) required; Eastern Time preferred.

Benefits

• Annual Compensation: $60,000-80,000 (full-time)
• Full Health Benefits: Medical, dental, and vision
• Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave.
• Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.