Healthcare Revenue Cycle Management Specialist

We are seeking a detail-oriented and proactive RCM professional to manage end-to-end healthcare revenue cycle operations, ensure accurate billing, minimize claim denials, and support timely revenue realization. The ideal candidate should have strong knowledge of insurance processes, claims management, and healthcare practice management software.

Requirements

Key Responsibilities

Manage the complete RCM workflow, including patient scheduling, insurance eligibility and benefits verification, pre-determinations (Pre-Ds), claims processing, payments, ERAs, denials, accounts receivable (AR), reconciliation, and patient follow-ups. Review payer guidelines, coverage history, service frequencies, benefit limitations, out-of-network (OON) benefits, and documentation to identify potential billing issues.

Monitor appointments, claims, outstanding balances, payments, denials, and follow-ups while maintaining accurate records and resolving discrepancies across systems. Investigate complex account issues and coordinate with payers and clients to ensure timely resolution from initial verification to final account closure. Identify claim rejection and denial trends, follow up on unpaid or underpaid claims, and support timely resubmissions and appeals to minimize revenue loss.

Maintain detailed account documentation, ensure compliance with payer requirements, and recommend process improvements to enhance billing accuracy and operational efficiency. Required Software Knowledge Hands-on experience with one or more of the following platforms: Dentrix Dentrix Ascend Therapy. Notes Simple. Practice Headway