RCM Specialist
Core
Managing the foundational stages of the reimbursement cycle, including initial and mid-stay authorizations, payor notifications, and billing system triaging to ensure steady revenue flow and prevent coverage gaps.
Role type
Healthcare Revenue Cycle Management (RCM) Specialist
Builds
Revenue capture and financial stability for behavioral health treatment services
Domain
Behavioral Health / Mental Health / Healthcare Administration
Deliverable
client delivery
Required skills
Prior authorization processes, payor portal navigation, medical billing practices, RCM billing systems, HIPAA compliance, worklog triaging, policy change management
Preferred skills
None stated
Technologies
RCM billing systems, payor portals
Responsibilities
Submitting initial authorization requests and tracking progress to ensure coverage prior to service delivery; Managing and submitting new policy authorization requests for clients with mid-treatment coverage changes; Issuing timely non-admission notifications to payors; Triaging and prioritizing daily worklog tasks to resolve bottlenecks; Executing ad hoc authorization and billing tasks to support department workflows
Seniority
Mid-level, hands-on IC