RCM Specialist II

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