RCM Specialist

• A/R Follow -Up: Systematically review and follow up on outstanding insurance claims that have aged beyond standard payment cycles, prioritizing accounts based on value and age.
  

• Denial Analysis & Resolution: Analyze Explanation of Benefits (EOB), Remittance Advices (RA), and denial codes to determine the root cause of non -payment.
  

• Appeals Management: Prepare and submit well -researched, customized appeals to payers for denied claims (e.g., medical necessity, lack of authorization, timely filing) using appropriate supporting clinical documentation and payer -specific guidelines.
  

• Payer Communication: Proactively contact insurance companies (via phone, website portals, or written correspondence) to check claim status, challenge underpayments, and negotiate resolution for complex A/R issues.
  

• Underpayment Review: Identify and investigate claims paid incorrectly or below contracted rates, initiating the necessary steps to recover the difference.
  

• Trend Identification: Document and escalate denial trends, coding issues, or payer process changes to management and the billing team to facilitate process improvement and prevention of future denials.
  

• Reporting: Maintain detailed documentation of all follow -up and denial resolution steps in the billing system notes. Generate A/R performance reports as required.
  

Requirements

• Education: High School Diploma or equivalent required. Associate’s or Bachelor’s degree in a relevant field preferred.
  

• Experience: Minimum 2 -3 years of dedicated experience in Accounts Receivable follow -up and denial management within US Healthcare RCM.
  

• Technical Skills: Advanced proficiency in RCM/Practice Management Systems. Expert use of payer portals (e.g., Availity, Navinet) for claims status and eligibility. Strong knowledge of EOBs, RAs, and standard denial/adjustment codes.
  

• Excellent critical thinking and analytical skills to interpret complex denial reasons.
  

• Strong written and verbal communication skills for effective payer negotiations and professional appeals drafting. 
  

• Results -oriented and highly persistent in follow -up.
  

• Other Proven ability to meet strict A/R aging and collection targets. Thorough understanding of the insurance appeals process across major payer types.