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