Position Summary
The RCM Specialist II independently manages full-cycle revenue cycle processes from eligibility and authorization through claims submission, denial resolution, and accounts receivable management. This role operates with minimal supervision and brings advanced payer knowledge and problem-solving skills to the billing team. RCM Specialist II staff also provide peer guidance and contribute to workflow improvement initiatives.
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
- Independently manage full-cycle billing and authorization workflows for assigned payers and patient groups
- Conduct advanced benefit reviews and clearly communicate cost-share details, including deductibles, co-pays, and out-of-pocket maximums
- Investigate and resolve claim denials, underpayments, and payer discrepancies by submitting timely appeals and corrected claims
- Complete corrected claims, update coordination of benefits (COB) information, and process secondary claims with accuracy
- Perform detailed ledger reviews to identify billing errors, unapplied payments, and reconciliation issues
- Monitor aging accounts receivable (AR) reports and proactively pursue resolution of outstanding balances
- Identify payer trends, recurring denial patterns, workflow gaps, and communicate insights to leadership
- Initiate and negotiate payment plans or financial arrangements for past-due patient balances
- Accurately post payments, adjustments, and remittances in the EMR/practice management system
- Support onboarding efforts and provide peer training and guidance to RCM Specialist I team members
- Assist in quality assurance reviews and participate actively in process improvement initiatives
- Communicate professionally with payers, families, and internal stakeholders to resolve billing concerns
- Maintain strict compliance with all healthcare regulations, coding standards, and payer-specific billing requirements
Essential Skills
- Highly organized with the ability to independently manage multiple payer accounts and complex billing workflows
- Strong analytical ability to identify denial trends, troubleshoot errors, and propose corrective actions
- Clear and professional communication skills; confident in addressing escalations with payers
- Advanced proficiency in Microsoft Office applications (Word, Excel, Outlook, PowerPoint)
- Strong understanding of medical terminology, ICD-10/CPT coding, and payer billing guidelines
- Experience with practice management and EMR systems (Raintree preferred)
Minimum Qualifications
• Associate degree or equivalent combination of education and experience; Bachelor's degree preferred
• 3–6 years of experience in full-cycle healthcare billing, authorizations, collections, and payment posting
• Demonstrated experience resolving complex denials, underpayments, and COB issues
• Experience in speech, occupational, or physical therapy billing preferred but not required
• Raintree EMR and Waystar clearinghouse experience preferred
