What are the responsibilities and job description for the RCM Specialist - HealthCare (SDQ) position at Hire Horatio CX?
Position Summary:
Horatio is hiring RCM Specialists to manage post-submission healthcare claims for a U.S. organization. Operating within the CandidHealth platform, you will execute SOP-driven workflows, including denial management, appeals, and prior authorizations to ensure timely revenue recovery. This role requires close attention to detail and expertise in healthcare insurance workflows.
Responsibilities:
- Conduct outbound calls to payers to investigate and resolve claim denials.
- Maintain precise call notes and claim updates within CandidHealth.
- Retrieve medical records and upload them to payer portals like UHC, Optum, and Availity.
- Process claim appeals following strict client SOPs and track progress to completion.
- Identify authorization issues on denied claims and coordinate required documentation for approval.
- Process claim appeals following strict client SOPs and track progress to completion.
- Identify authorization issues on denied claims and coordinate required documentation for approval.
Required Skills/Abilities:
- 1–3 years in Healthcare RCM or medical billing.
- Experience working with insurance claims, denials, or appeals workflows
- Fluent English (C1 level preferred) with strong payer outreach skills.
- Ability to thrive in high-volume, queue-based, and SOP-driven environments.
- Attention to detail and documentation accuracy
- Familiarity with RCM platforms (CandidHealth preferred) and payer portals.
- Knowledge of HIPAA and healthcare data privacy.
Benefits:
- Insurance under ARS Humano Royal Plan (Option to upgrade to Max Royal Plan)
- Free snacks every day
- Free catered lunch every day
- Free catered dinner (for those on night shifts)
- Door-to-door transportation after 9:00 PM
- Happy hour on Fridays
- Holiday parties!
- An amazing, unique office environment (no cubes, no assigned workstations!)
- Growth and development opportunities (the most in the industry!)
- Professional development courses by leading business schools like Barna
- Yoga and workout classes
- Community service opportunities (#HoratioCares)
- Discounts at local restaurants and stores