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