Position Summary
The RCM Specialist I is an entry-level position focused on learning and executing core revenue cycle functions under guided supervision. This role provides a foundational pathway into full-cycle revenue cycle management, with an emphasis on accuracy, compliance, and developing strong billing fundamentals across eligibility verification, authorizations, claims submission, and accounts receivable follow-up.
Job Details
Work setup: Onsite (Eastwood)
Schedule: Monday to Friday, 10PM - 7AM Manila Time
Holiday arrangement: US Holidays (Client’s Holiday Calendar)
Essential Duties & Responsibilities
- Perform insurance eligibility checks and benefit verification for all scheduled patients prior to service delivery
- Initiate standard prior authorization requests and track renewal timelines with guidance from senior team members
- Submit clean and accurate claims within established workflows in the practice management system, ensuring timely filing
- Monitor assigned accounts receivable (AR) dashboards and follow up on straightforward unpaid or pending claims
- Escalate complex denial trends, payer disputes, and authorization challenges to RCM Specialist II or Senior team members
- Review patient ledgers for accuracy and completeness under the supervision of senior or managerial staff
- Accurately post payments, adjustments, and remittances in the EMR/practice management system
- Document all claim activity, follow-up actions, and payer communications clearly and consistently within EMR/RCM systems
- Communicate with families regarding basic benefit information and general insurance coverage questions
- Comply with all healthcare regulations, coding guidelines, and payer-specific policies
- Participate actively in team meetings, scheduled training, and ongoing professional development opportunities
- Assist with special billing projects and process improvement initiatives as assigned by leadership
Essential Skills
- Organized and detail-oriented with strong written and verbal communication skills
- Customer-service focused with a professional and respectful communication style
- Ability to follow established workflows with accuracy and ask questions proactively
- Basic proficiency with Microsoft Office (Word, Excel, Outlook)
- Foundational understanding of medical terminology and healthcare billing concepts
- Comfortable working onsite and collaborating closely with team members, especially during training
Minimum Qualifications
- Associate degree or an equivalent combination of education and experience
- 0–3 years of experience in healthcare billing, collections, pre-authorizations, or payment posting
- Open to candidates with limited or no direct RCM experience, provided they have a healthcare-related background (e.g., experience in a medical or clinic office setting, or a clinical background such as nursing)
- Familiarity with medical terminology and healthcare workflows required; strong aptitude for learning RCM processes is essential
- Experience in physical therapy, speech therapy, or occupational therapy billing is considered a nice-to-have but not mandatory
- Raintree EMR experience preferred but not required
