RCM & Billing Specialist

Position Summary 

The RCM & Billing Specialist is responsible for supporting the day-to-day revenue cycle operations, including billing, claims submission, payment posting, and collections follow-up. This role works closely with the RCM Manager to ensure accuracy, compliance, and timely reimbursement across all payers. 

This position plays a critical role in maintaining the financial health of the organization by ensuring clean claims, resolving denials, and identifying areas for process improvement. 

Key Responsibilities: 

• Submit accurate and timely claims to Medicaid and commercial payers  

• Review claims for errors and make corrections prior to submission  

• Monitor claim status and follow up on unpaid, delayed, or denied claims  

• Investigate denials and rejections, identify root causes, and resubmit claims as appropriate  

• Work accounts receivable (A/R) aging reports and assist with collections efforts  

• Accurately post insurance and patient payments and reconcile discrepancies  

• Maintain accurate and compliant billing documentation in accordance with payer and Medicaid guidelines  

• Identify and escalate trends in denials, rejections, or billing issues to the RCM Manager  

• Collaborate with clinical and operations teams to resolve documentation or authorization discrepancies  

• Assist with internal audits and ensure alignment between clinical services and billed services  

• Support workflow improvements and process optimization within the revenue cycle 

Work Environment:  

• Fast-paced, detail-oriented environment with high accountability  

• Requires consistent follow-through and timely resolution of billing issues  

• Frequent collaboration with clinical, operations, and administrative teams  

• Ability to work independently while maintaining strong communication with leadership 

Qualifications:  

• 1–3 years of experience in medical billing, revenue cycle, or healthcare administration  

• Experience with Medicaid and commercial insurance billing required; ABA experience preferred  

• Strong understanding of claims submission, denial management, and payment posting  

• High attention to detail and accuracy in data entry and documentation  

• Ability to manage multiple priorities in a fast-paced environment  

• Strong problem-solving and critical thinking skills  

• Proficient in EMR/EHR and billing systems (CentralReach experience preferred)  

• Strong communication and collaboration skills 

Preferred Qualifications:   

• Experience in ABA or behavioral health setting  

• Familiarity with CPT codes related to ABA services (e.g., 97153, 97155, etc.)  

• Experience working with Medicaid-specific billing requirements 

Salary : $50,000 - $55,000