RCM Specialist

This is a remote position.

Summary

The Accounts Receivable (A/R) Specialist is a critical role responsible for actively managing the collection of outstanding claims and resolving all payment denials. This position directly impacts the client’s cash flow and revenue realization by ensuring all legitimate claims are paid quickly and accurately.

Key Responsibilities

• 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.
  

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.