RCM Specialist II
Location
United States
Posted
26 days ago
Salary
$22 - $27 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
RCM Specialist II
Paradigm Oral Surgery
Role Description 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. Qualifications - Prior experience in Dental Office workflows, Revenue Cycle functions including Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up, and payment posting process. - Knowledgeable of reimbursement/compliance process and procedures with all payors. - Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software. - Proficient in intermediate PC skills (MS Office—strong Excel skills). - Strong computer literacy, excellent math and problem-solving skills. - Data entry and 10-key by touch. - Strong interpersonal and organizational skills. - Ability to work within a team setting and as an individual contributor. - Excellent oral and written communication skills. - Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures. - Organized work habits, accuracy, and proven attention to detail with strong analytical skills. - Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred. Requirements - 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. - Monitor and report on the net collection rate, analyzing performance against targets. - 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. - Review and analyze the percentage of AR over 90 days (insurance v. patient) to identify trends or issues requiring attention. - Identify trends in rejections, disputes, payment delays, and denials, and escalate issues for resolution. - Maintain respect and professionalism in all interactions with internal stakeholders, patients, payers, third parties, and others.
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