The Revenue Cycle Management (RCM) Specialist I performs foundational revenue cycle functions including claim follow-up, denial resolution, payment review, account research, and payer communication. This role supports timely claim resolution, accurate reimbursement, and departmental workflow needs.
The Specialist I demonstrates working knowledge of revenue cycle processes while maintaining productivity, accuracy, and compliance standards. This position collaborates with team members to support overall departmental operations and contributes to a high-performing revenue cycle team.
Leadership and team expectations
- Model professionalism and accountability in all interactions
- Communicate clearly and respectfully with payers, team members, and supervisors
- Collaborate effectively to resolve account issues and support team workflows
- Uphold the organization's mission and values in all work performed
- Demonstrate reliability by consistently meeting productivity, quality, and attendance expectations
- Engage in learning and skill development to support growth within the department
Core responsibilities
- Review and follow up on outstanding claims to ensure timely processing and reimbursement
- Research and resolve claim issues, discrepancies, and payer requests
- Submit corrected claims, appeals, or additional documentation as required
- Communicate with payers to clarify claim issues and obtain resolution
- Monitor claim status and ensure timely follow-up until payment or final determination
- Review payments for accuracy and identify incorrect adjustments
- Conduct account research to determine next steps for unresolved claims
- Document all actions clearly and accurately in the appropriate systems
- Maintain accurate documentation for all account activity
- Ensure compliance with billing regulations, payer requirements, and internal policies
- Protect PHI and follow HIPAA standards at all times
- Save all work files to the shared drive in accordance with data security requirements
- Assist with workflow needs and process updates as directed
- Support team communication and coordination
- Perform other duties as assigned consistent with this role
Performance expectations
- Claims are followed up on promptly and resolved efficiently
- Documentation is accurate, complete, and timely across all accounts
- Denials are reduced through effective follow-up and corrective action
- Team members view this person as reliable and communicative
- Productivity and quality standards are consistently met or exceeded
- Remote work expectations are consistently met, including responsiveness, workspace compliance, and availability
Requirements & Qualifications
- High school diploma or equivalent
- Experience in revenue cycle, medical billing, accounts receivable follow-up, or denial management
- Demonstrated ability to meet productivity and quality expectations
- Strong written and verbal communication skills with payers and internal teams
- Ability to problem-solve and research account issues independently
- Strong organizational skills and attention to detail
- Ability to work independently and meet productivity expectations in a remote environment
- Ability to manage competing priorities in a fast-paced workflow
- Knowledge of revenue cycle processes including claim follow-up, denial management, and payment review
- Basic payer rules, denial types, and insurance processes
- HIPAA regulations and PHI protection requirements
- Electronic health record or billing system fundamentals
- Preferred experience in behavioral health or community health settings
- Familiarity with Medicaid, Medicare, and commercial payers
- Experience with EHR or billing platforms such as Netsmart, Epic, or similar
Location
Illinois, US
Employment Type
Part-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago