RCM Specialist II

Job Description

Job Description

ROLE OVERVIEW

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 : Monitor and report on the net collection rate, analyzing performance against targets. Collaborate with the team to identify opportunities for improvement.
• Days in AR : Track and evaluate average days in AR to ensure appropriate advanced collection, payment application, efficient and accurate claim filing, and timely back-end billing and claim resolution. Investigate and address any delays or bottlenecks that may be causing extended days in AR.
• % AR Over 90 Days : Review and analyze the percentage of AR over 90 days (insurance v. patient) to identify trends or issues requiring attention. Work with the team to reduce the percentage of aged receivables by implementing strategies to resolve outstanding claims and payments.
• 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

Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred