RCM Coordinator - Claims Resolution

General Description Are you looking for a purpose-driven career? At Metrocare, we serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. Metrocare is the largest provider of mental health services in North Texas, serving over 55,000 adults and children annually. For over 50 years, Metrocare has provided a broad array of services to people with mental health challenges and developmental disabilities. In addition to behavioral health care, Metrocare provides primary care centers for adults and children, services for veterans and their families, accessible pharmacies, housing, and supportive social services. Alongside clinical care, researchers and teachers from Metrocare’s Altshuler Center for Education & Research are advancing mental health beyond Dallas County while providing critical workforce to the state. Job Description The mission of Metrocare Services is to serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. We are an agency committed to quality gender-responsive, trauma-informed care to individuals experiencing serious mental illness, developmental disabilities, and co-occurring disorders. Metrocare programs focus on the issues that matter most in the lives of the children, families and adults we serve. The RCM Coordinator – Claims Resolution serves as a key financial liaison within the Revenue Cycle Management team, responsible for ensuring the integrity of claim submission, payment accuracy, and denial prevention across multiple service lines including primary care, behavioral health, intellectual and developmental disability (IDD) services, early childhood intervention (ECI), applied behavior analysis (ABA) therapy, and LIDDA programs. This position requires advanced understanding of payer policy variations, reimbursement methodologies, and system workflows. The role coordinates closely with clinical, compliance, and finance teams to safeguard and optimize agency revenue performance. Essential Duties and Responsibilities Prepare, review, and submit claims for primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services to Medicaid, Medicare, and commercial payers. Monitor claim status and ensure timely acceptance, adjudication, and payment across multiple service lines. Research and resolve claim denials, rejections, and underpayments specific to medical, behavioral health, and developmental disability services. Partner with clinical and administrative teams to ensure proper coding, documentation, and authorization for services provided. Maintain current knowledge of payer policies, rules, and regulatory requirements for mental health, primary care, ABA therapy, IDD, ECI, and LIDDA programs. Track denial and rejection trends across all service areas, identify root causes, and recommend corrective action. Document claim activity, correspondence, and resolution steps accurately in the billing system. Provide reporting and analysis to management regarding claim performance, payer trends, and process improvement opportunities. Collaborate with the Revenue Cycle Management team to ensure compliance and revenue integrity across all program areas. Performs other duties as assigned. Competencies Conducts job responsibilities in accordance with the ethical standards of conduct, state contract, appropriate professional standards and applicable state/federal laws. Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills. Performance Accountability Metrics Maintain Ensure 95% of claims are submitted within five business days of service posting. Achieve average monthly collection cycle under 45 days. Maintain payer reconciliation accuracy above 98%. Knowledge of claim submission, denial management, and payer-specific rules Medicare, Medicaid, MCOs, Commercial, and other specialty payors. Ability to interpret payer contracts, fee schedules, and reimbursement policies. Proficiency with Availity, TMHP, or similar clearinghouse portals. Working knowledge of pivot-table reconciliation, payer remittance analytics, and denial trend dashboards. Conducts job responsibilities in accordance with ethical standards, state contracts, professional guidelines, and applicable state/federal laws. Strong analytical and problem-solving skills. Effective verbal and written communication skills. Excellent organizational skills with the ability to prioritize workflow and meet deadlines. Ability to manage multiple tasks and special projects simultaneously. Maintains a high level of professionalism, accuracy, and confidentiality. Qualifications Required Education: High school diploma or GED; at least 5 years of experience in medical billing, claims processing, or revenue cycle management. Preferred Education: Associate’s degree in healthcare administration, business, or related field; experience in billing and knowledge of Community Center Services; knowledge of ICD-10, CPT, HCPCS, and modifier usage; familiarity with Medicaid, Medicare, Certified Professional Biller (CPB), Certified Revenue Cycle Specialist (CRCS), or Certified Professional Coder (CPC), and commercial insurance requirements. A bachelor's degree will be accepted in place of experience. DRIVING REQUIRED: No Work Location This role is remote except for 6 weeks of onsite training and monthly meetings. Mathematical Skills Basic math skills required. Ability to work with reports and numbers & Ability to calculate moderately complex figures and amounts to accurately report activities and budgets. Reasoning Ability Ability to apply common sense understanding to carry out simple one or two-step instructions. Strong reasoning and problem-solving skills with the ability to make informed decisions in a dynamic and client-centered environment. Ability to calculate figures for claim reconciliation and payment posting. Strong attention to detail and ability to adapt to payer policy variations. Computer Skills Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint). Ability to utilize Internet for resources. Physical Demands & Work Environment The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations can be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the incumbent is regularly required to talk and hear, use hands and fingers to operate a computer and telephone. Due to the multi-site responsibilities of this position the incumbent must be able to carry equipment and supplies. Demand-Frequency Sitting- Frequent Walking- Frequent Standing- Frequent Lifting (Up to 15 pounds)-Occasional Lifting (Up to 25 pounds)-Occasional Lifting (Up to 50 pounds)-Occasional Travel-Frequency In county travel may be required-N/A Overnight travel required-N/A Notice on positions that require travel to/from various worksites: Positions that are “community-based,” in whole or part, require the incumbent to travel between various worksites within his/her workday/workweek. The incumbent is required to have reliable transportation that can facilitate this requirement. The incumbent is further required to meet the criteria for insurability by the Center’s risk management facilitator; and produce proof of minimal auto liability coverage when applicable. Failure to meet these terms may result in disciplinary action up to and including termination of employment, contract or other status with Metrocare. Current State of Texas Driver License or if you live in another state, must be currently licensed in that state. If licensed in another state, must obtain Texas Driver License within three (3) months of employment. Liability insurance required if employee will operate personal vehicle on Center property or for Center business. Must be insurable by Center’s liability carrier if employee operates a Center vehicle or drives personal car on Center business. Must have an acceptable driving record. Work Environment The work environment describe here is representative of that which an employee encounters while performing the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions. Employees in this role are expected to maintain composure under pressure, exercise sound judgment, and follow established protocols to ensure a safe and secure work environment. Ongoing training in crisis intervention, de-escalation techniques, and workplace safety is provided. Additionally, employees have access to resources such as the Employee Assistance Program (EAP), Telehealth Counseling, and Supportive Management. Remote Work Eligible - May work remotely for documentation and administrative tasks, through some in-person meetings or fieldwork is required. Disclaimer This job description is a record of major aspects of the job but is not an all-inclusive job contract. Dallas Metrocare Services maintains its status as an “at-will” employer and nothing in this job description shall be interpreted to guarantee employment for any length of time. Additional tasks may be assigned as deemed necessary by the immediate supervisor. The position’s status conforms to the Fair Labor Standards Act of 1939 as amended, and the employee has agreed to the standards methods of compensation in compliance with Center’s procedures and Federal Law. Benefits and Perks Medical/Dental/Vision Paid Time Off Paid Holidays Employee Assistance Program Retirement Plan, including employer matching Health Savings Account, including employer matching Professional Development allowance up to $2000 per year Bilingual Stipend – 6% of the base salary Many other benefits Equal Employment Opportunity/Affirmative Action Employer Tobacco-Free Facilities – Metrocare is committed to promoting the health, well-being, and safety of Metrocare team members, guests, and individuals and families we serve while on the facility campuses. Therefore, Metrocare facilities and grounds are tobacco-free. No Recruitment Agencies Metrocare is the largest provider of mental health, developmental disability and permanent supported housing services in Dallas County serving over 50,000 children, teens and adults annually. For over 55 years, Metrocare has provided a broad array of services from mental health care, primary care, services for veterans and their loved ones, accessible pharmacies, homeless outreach, and supportive social services. Metrocare provides specialty mental health services to over 10,000 children and teens and has numerous programs for babies, children and adults with disabilities, including Early Childhood Intervention, Flourishing Families, Nurturing Parenting, Supported Employment and two specialty autism clinics in Dallas and DeSoto. Metrocare’s Altshuler Center for Education & Research is the premier training and research institute for community mental health professionals across Texas. Metrocare upholds the person-centered philosophy to focus care on the needs of individual. We take care to ensure that people’s preferences, needs and values guide clinical decisions and to provide care that is respectful of and responsive to those we serve. We see ourselves as partners in healing with our clients and their support network. #J-18808-Ljbffr Metrocare Services