RCM Specialist

RCM Specialists are responsible for supporting day-to-day RCM operations, including claims management, payment posting, denial resolution, and account follow-up. They work closely with Account Managers and other team members to ensure timely and accurate revenue capture. This role requires strong attention to detail, a proactive mindset, and a commitment to continuous improvement, along with deep expertise in eClinicalWorks (ECW). Candidates must be ECW superusers with in-depth knowledge of its implementation and functionality, as this system is central to our workflows. The work of our RCM Specialists directly impacts client satisfaction, revenue performance, and overall team success.

This is a full-time, non-exempt position reporting to an RCM Account Manager.

What You Will Do

· Ensure timely and accurate submission of claims to payers (government, commercial, and third-party)

· Review and verify patient insurance information and eligibility

· Conduct detailed account reviews to identify and resolve denied or rejected claims

· Work payer follow-up queues to ensure timely reimbursements and reduce outstanding accounts receivable

· Post payments and adjustments accurately to patient accounts

· Monitor aging reports and escalate unresolved issues appropriately

· Collaborate with internal teams including coding, credentialing, and customer service

· Maintain compliance with payer requirements and industry regulations (e.g., HIPAA)

· Identify trends in denials or underpayments and contribute to process improvements

· Respond to patient billing inquiries with professionalism and clarity

Qualifications & Skills

· High school diploma or equivalent required; Associate’s or bachelor’s degree in healthcare administration or related field preferred

· 3+ years of experience in medical billing, collections, or revenue cycle operations

· Must be an eClinicalWorks (ECW) superuser with in-depth knowledge of ECW implementation and functionality.

· Familiarity with other electronic health records and practice management systems is a plus.

· Experience in pain management billing is a plus

· Working knowledge of CPT, ICD-10, and HCPCS coding systems

· Strong understanding of insurance guidelines, EOBs, and remittance advice

· Excellent organizational and communication skills

· Ability to function well in a fast-paced and at times stressful environment.

· Prolonged periods of sitting at a desk and working at a computer. Ability to lift and carry items weighing up to 10 pounds at times.