RCM Specialist III

Revenue Cycle Management (RCM) Specialist III Health Choice Network is seeking a Revenue Cycle Management (RCM) Specialist III to manage complex billing, denial, and reimbursement issues while driving process improvements across revenue cycle operations. This role serves as a subject matter expert (SME) for revenue cycle functions, provides mentorship to team members, supports system optimization initiatives, and collaborates with leadership to enhance operational performance and maximize reimbursement outcomes. Key Responsibilities: Analyze complex accounts receivable (A/R) trends, denials, and claim rejections to identify root causes and implement corrective actions. Collaborate with payers and internal stakeholders to resolve escalated billing and reimbursement issues. Lead maintenance and optimization of Practice Management (PM) billing support files, fee schedules, insurance plans, and billing codes. Serve as a subject matter expert for revenue cycle staff by providing training, guidance, and issue resolution support. Develop, test, and implement system workflows, process improvements, and best practices in partnership with leadership. Support advanced reporting, analytics, and quality assurance activities related to financial, encounter, billing, and performance metrics. Develop and maintain workflow documentation, training materials, and operational guides for internal staff and member centers. Monitor payer updates, regulatory changes, and software enhancements to ensure compliance and operational readiness. Participate in special projects and perform additional duties as assigned to support organizational goals. Qualifications: Associate's or Bachelor's degree in Healthcare Administration, Finance, Business Administration, or a related field preferred. Minimum of 5 years of progressive experience in revenue cycle operations, including advanced billing, collections, reimbursement, and denial management. Expert knowledge of revenue cycle processes, payer regulations, reimbursement methodologies, and claims management. Experience with POMIS or similar Practice Management (PM) systems. Familiarity with Electronic Data Interchange (EDI) tools and revenue cycle reporting platforms. Strong analytical, problem-solving, and decision-making skills. Excellent written, verbal, and interpersonal communication skills. Demonstrated ability to manage multiple priorities while maintaining accuracy and attention to detail in a fast-paced environment. Preferred Qualifications: Experience supporting multi-site healthcare organizations, Federally Qualified Health Centers (FQHCs), or physician practice groups. Advanced experience with revenue cycle analytics and performance reporting. Knowledge of healthcare compliance requirements related to billing and reimbursement. Experience leading process improvement initiatives and workflow optimization projects. Prior experience training, mentoring, or supervising revenue cycle team members. What We Offer: 100% Remote Work – Work from anywhere in the U.S. 100% Employer-Paid Medical Insurance Annual $1,500 HSA Contribution Generous Paid Time Off (PTO) 403(b) Retirement Plan with Employer Contribution Professional Development & Education Assistance Mission-Driven Culture Focused on Community Health Health Choice Network