RCM Specialist Professional

Key Responsibilities

• Process and manage the complete revenue cycle, including charge entry, claim submission, payment posting, denial management, and AR follow-up.
• Review claim rejections and denials, identify root causes, and take corrective actions for timely reimbursement.
• Follow up with commercial, Medicare, Medicaid, and Workers' Compensation payers through portals and phone calls.
• Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) to ensure accurate payment posting.
• Resolve underpayments, coding edits, authorization issues, eligibility errors, and documentation deficiencies.
• Escalate complex billing issues to Coding, Credentialing, Client Success, or Practice Management teams when required.
• Monitor aging reports and prioritize high-value accounts to reduce outstanding AR.
• Meet productivity, quality, and turnaround time (TAT) targets.
• Prepare daily, weekly, and monthly operational reports and communicate key performance metrics.
• Identify process improvement opportunities to improve First Pass Payment Rate (FPPR), reduce denials, and improve cash collections.
• Train and mentor junior associates while providing guidance on payer-specific billing requirements.
• Ensure compliance with HIPAA, payer policies, and client-specific standard operating procedures (SOPs)