RCM Specialist

About Us

We are a leading national primary mental health treatment provider offering a full continuum of care, including residential, PHP, IOP, and outpatient services. Our organization is committed to delivering high-quality care while optimizing revenue cycle performance across our network.

Position Summary

We are seeking a highly skilled RCM Specialist with out-of-network (OON) expertise to support our revenue cycle operations. The ideal candidate will have hands-on experience in behavioral health medical collections, utilization review (UR), and billing, with a strong understanding of payer dynamics and reimbursement strategies in an OON environment.

Key Responsibilities

• Manage revenue cycle processes with a focus on out-of-network (OON) billing and collections
• Submit, track, and follow up on insurance claims to ensure timely reimbursement
• Perform medical collections and aggressively pursue outstanding balances
• Review, analyze, and resolve claim denials, underpayments, and rejections
• Prepare and manage appeals and reconsiderations for OON claims
• Collaborate with Utilization Review (UR) to ensure proper authorization, documentation, and medical necessity alignment
• Verify benefits and understand OON reimbursement structures and policies
• Post payments and reconcile accounts accurately
• Communicate with insurance companies to negotiate and secure appropriate reimbursement
• Maintain compliance with payer requirements and internal policies
• Track KPIs including AR aging, collections performance, and denial trends

Qualifications

• 2+ years of experience in revenue cycle management with a strong OON focus
• Proven experience in behavioral health medical collections, UR, and billing
• Deep understanding of out-of-network reimbursement strategies and payer behavior
• Experience handling appeals, denials, and underpayment recovery
• Familiarity with behavioral health levels of care (PHP, IOP, residential, outpatient)
• Experience with EMR systems (e.g., KIPU or similar) preferred
• Knowledge of CPT/ICD-10 coding and claims lifecycle
• Strong negotiation, problem-solving, and communication skills
• Ability to work independently in a fast-paced, multi-site environment

Preferred Qualifications

• Experience working in a multi-state or national behavioral health organization
• Strong background in high-dollar collections and complex claims resolution
• Advanced Excel or reporting skills

Compensation & Benefits

• Competitive salary (based on experience)
• Health, dental, and vision insurance
• Paid time off and holidays
• Career growth opportunities within a national organization

Pay: $50,000.00 - $80,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• behavioral health RCM: 3 years (Required)
• medical billing and collections: 3 years (Required)
• OON: 2 years (Required)

Work Location: In person