What are the responsibilities and job description for the RCM Specialist III position at Legacy Community Health?
- Paid Time Off & Paid Company Holidays
- Medical, Dental, Vision & Life Insurance
- Flexible Spending Account (FSA)
- 403(b) Retirement Plan with Company Match
- Short-Term & Long-Term Disability
- $0 Copay for Legacy Provider visits
- $0 Copay for prescriptions filled at Legacy Pharmacies
- Travel Insurance & Pet Insurance
- Subsidized Gym Membership
- And much more!
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Location: Legacy Montrose Allen Parkway - 2929 Allen Pkwy. Houston, TX 77019RCM Specialist III - Job Overview
Schedule: 8AM-5PMWelcome to Legacy Community Health, where your career is more than just a job—it's a chance to make a real difference. As an RCM Specialist III, you'll be at the heart of our mission to provide equitable, high-quality healthcare for all. This isn't just a role; it's an opportunity to be part of a compassionate team that values your expertise and passion for helping others.
In this role, you'll leverage your skills in revenue cycle management to ensure patients receive crucial specialty injectable medications. You'll be an advocate, a collaborator, and a problem-solver, working with a team that shares your dedication to creating meaningful change.
- Impactful Role: Your work ensures patients have access to life-saving medications, directly supporting our mission to drive health equity
- Supportive Team: You’ll join a warm, collaborative environment where your contributions are celebrated and your growth is nurtured
- Professional Development: Enjoy mentorship opportunities, access to loan repayment programs, and pathways to advance your career
- Work-Life Balance: Thrive in a role that prioritizes your well-being, fostering both personal and professional fulfillment
- Manage and optimize billing and collections processes for accurate and timely submission of claims
- Develop strategies to minimize claim denials and rejections, ensuring adherence to payer requirements
- Monitor accounts receivable (AR) metrics and proactively reduce outstanding balances
- Utilize advanced knowledge of medical billing codes (CPT, HCPCS, ICD-10) to ensure precise coding
- Ensure compliance with regulatory requirements and insurance guidelines to eliminate billing discrepancies
- Reconcile payments with billed amounts, addressing discrepancies and ensuring accurate posting
- Navigate complex authorization processes for specialty injectable medications, collaborating with providers, pharmacies, and insurance carriers
- Advocate for patients by ensuring clinical documentation accuracy and communicating justifications effectively
- Streamline workflows to reduce turnaround times for medical authorizations
- Conduct benefit and coverage reviews, analyzing insurance policies for eligibility
- Evaluate clinical documentation and diagnostic criteria to ensure payer compliance
- Utilize EPIC software for billing, scheduling, and maintaining patient records
- Ensure adherence to healthcare regulations, including HIPAA and Medicare/Medicaid guidelines
- Maintain secure electronic records of patient interactions and financial data
- Stay updated on changes in healthcare laws and regulations affecting revenue cycle management
- High School Diploma/GED required; Bachelor’s Degree preferred
- Minimum of 10 years of progressive experience in revenue cycle management within a healthcare environment
- Specific expertise in medical authorizations for specialty injectable medications
- Proven track record of improving revenue cycle performance metrics and reducing AR days
- Basic to intermediate proficiency in Excel
- EPIC Certification preferred
- Excellent oral and written communication skills, customer service abilities, and understanding of medical terminology
- Strong analytical, organizational, and time management skills
- Ability to multitask in a fast-paced environment, work with minimal supervision, and manage multiple deadlines
- Competency with EHRS systems
- Access to confidential and sensitive information requiring discretion and secure management
At Legacy Community Health, our mission—Driving healthy change in our communities—guides everything we do. To fulfill this mission, every team member is expected to embody the following core attributes in their daily work, regardless of role or department:
Approachable & CollaborativeWe bring our expertise without ego. In a collaborative healthcare environment, humility fosters trust and teamwork. Our employees value diverse perspectives, seek input from others, and are unafraid to acknowledge when they need help. We stay grounded in our purpose: to serve patients and communities with compassion and humility.
Driven & CommittedWe are driven by a deep commitment to excellence in patient care and organizational improvement. Our employees take initiative, embrace challenges, and go the extra mile to support our mission. Whether improving patient outcomes, streamlining processes, or stepping up in times of need, we are always striving to drive healthy change—within ourselves, our teams, and the communities we serve.
Perceptive & Thoughtful CommunicatorsWe value emotional intelligence as much as clinical or technical skill. Our team members demonstrate sound judgment, cultural sensitivity, and the ability to navigate complex situations with empathy and professionalism. They communicate clearly and respectfully with patients, families, and colleagues, building trust and fostering a safe, inclusive environment for all.