About the role
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
- TherapyNotes
- SimplePractice
- Headway