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Job Title: Revenue Cycle Management Specialist I
Reports to: Revenue Cycle Manager
Accountable to: Senior Director of Revenue Cycle Management
Schedule: Monday–Friday, standard business hours
FLSA Status: Non-Exempt
Position Type: Part-Time
Work Setting: Remote
Position Overview:
The Revenue Cycle Management (RCM) Specialist I performs foundational revenue cycle functions including claim follow-up, denial resolution, payment review, account research, and payer communication. This role supports timely claim resolution, accurate reimbursement, and departmental workflow needs. The Specialist I demonstrates working knowledge of revenue cycle processes while maintaining productivity, accuracy, and compliance standards.
This position collaborates with team members to support overall departmental operations and contributes to a high-performing revenue cycle team. The Specialist I builds core skills needed for advancement into more complex revenue cycle responsibilities.
Leadership & Team Expectations:
Model professionalism and accountability in all interactions
Communicate clearly and respectfully with payers, team members, and supervisors
Collaborate effectively to resolve account issues and support team workflows
Uphold Heritage’s mission and values in all work performed
Demonstrate reliability by consistently meeting productivity, quality, and attendance expectations
Engage in learning and skill development to support growth within the department
Core Responsibilities Include:
Claim Follow-Up & Resolution
Review and follow up on outstanding claims to ensure timely processing and reimbursement
Research and resolve claim issues, discrepancies, and payer requests
Submit corrected claims, appeals, or additional documentation as required
Communicate with payers to clarify claim issues and obtain resolution
Monitor claim status and ensure timely follow-up until payment or final determination
Payment Review & Account Research
Review payments for accuracy and identify incorrect adjustments
Conduct account research to determine next steps for unresolved claims
Document all actions clearly and accurately in the appropriate systems
Documentation & Compliance
Maintain accurate documentation for all account activity
Ensure compliance with billing regulations, payer requirements, and internal policies
Protect PHI and follow all HIPAA standards at all times
Save all work files to the shared R: Drive in accordance with data security requirements
Team Support & Workflow
Assist with workflow needs and process updates as directed
Support team communication and coordination
Perform other duties as assigned consistent with this role
Performance Expectations / What Success Looks Like:
The Revenue Cycle Management Specialist I will be successful in this role when:
Claims are followed up on promptly and resolved efficiently
Documentation is accurate, complete, and timely across all accounts
Denials are reduced through effective follow-up and corrective action
Team members view this person as reliable and communicative
Productivity and quality standards are consistently met or exceeded
Remote work expectations are consistently met, including responsiveness, workspace compliance, and availability
Knowledge, Skills and Abilities:
Knowledge of:
Revenue cycle processes including claim follow-up, denial management, and payment review
Basic payer rules, denial types, and insurance processes
HIPAA regulations and PHI protection requirements
Electronic health record (EHR) or billing system fundamentals
Skills and Abilities:
Strong written and verbal communication skills with payers and internal teams
Ability to problem-solve and research account issues independently
Strong organizational skills and attention to detail
Ability to work independently and meet productivity expectations in a remote environment
Ability to manage competing priorities in a fast-paced workflow
Education and Experience:
Required:
High school diploma or equivalent
Experience in revenue cycle, medical billing, accounts receivable follow-up, or denial management
Demonstrated ability to meet productivity and quality expectations
Preferred:
Experience in behavioral health or community health settings
Familiarity with Medicaid, Medicare, and commercial payers
Experience with EHR or billing platforms such as Netsmart, Epic, or similar
Note: Equivalent combination of education and experience will be considered.
Physical Requirements and Working Conditions:
Ability to sit and work at a computer for extended periods
Reliable high-speed internet connection required
Must maintain a private, secure, and HIPAA-compliant remote workspace free from interruptions
Ability to maintain focus and productivity in a remote environment
Must follow all Heritage remote work, HIPAA, and data security requirements
