RCM Specialist

Revenue Cycle Management (RCM) Specialist Company: Pinnacle Healthcare Employment Type: Full-Time Location: Fully Remote Schedule: Eastern Time (ET) business hours Position Overview Pinnacle Healthcare is seeking an experienced Revenue Cycle Management (RCM) Specialist to support its billing, authorization, accounts receivable, and collections operations. This role is designed for an experienced professional who can contribute with minimal onboarding and training, ideally requiring no more than 1–2 days to become familiar with internal workflows. The ideal candidate will have hands-on experience in DME and respiratory billing, Medicare, Medicaid, payer portals, authorizations, and accounts receivable management. Experience with CareCentrix, New York Medicaid, Brightree, and Blue Cross Blue Shield of New Jersey is highly valued. This position will play an important role in maintaining accurate billing, resolving outstanding balances, managing payer requirements, and helping Pinnacle Healthcare clean up legacy accounts as the company transitions from Brightree to NikoHealth. Key Responsibilities Revenue Cycle & Billing Manage day-to-day revenue cycle activities across billing, claims, authorizations, AR, and collections. Process and review DME and respiratory billing accurately and efficiently. Understand billing based on units, calorie counts, and other applicable service requirements. Apply appropriate Medicare modifiers, diagnosis pointers, and billing codes. Review claims for accuracy and resolve billing discrepancies or rejected claims. Work with insurance companies and payer portals to resolve outstanding billing issues. Authorizations & Payer Management Process and maintain insurance authorizations, including recurring/monthly authorization requirements. Manage New York Medicaid authorizations and billing workflows. Utilize ePACES for Medicaid-related billing and authorization activities. Work within CareCentrix and other payer systems to manage authorizations, claims, and billing issues. Navigate payer portals such as Availity and NaviNet. Communicate directly with insurance representatives when portal-based resolution is unavailable. Monitor authorization status, expiration dates, cancellations, and required follow-up. Accounts Receivable & Collections Review and clean up outstanding and aging accounts receivable. Research unpaid, denied, or delayed claims and determine the appropriate resolution. Follow up with insurance companies and other payers regarding outstanding balances. Identify recurring billing or authorization issues contributing to delayed payments. Assist with legacy AR and collections cleanup in Brightree. Maintain accurate documentation and follow-up records throughout the revenue cycle. Systems & Technology Work primarily within Brightree during the company's transition to NikoHealth. Maintain accurate records across billing and payer systems. Learn and adapt to internal workflows and technology with minimal training. NikoHealth experience is a strong bonus, but not required. Required Qualifications Proven experience in revenue cycle management, medical billing, or healthcare billing. Hands-on experience with DME and/or respiratory billing. Strong understanding of Medicare billing requirements, modifiers, and diagnosis pointers. Experience with Medicaid, preferably New York Medicaid. Experience managing insurance authorizations and recurring authorization requirements. Experience with accounts receivable, aging reports, denied claims, and collections. Familiarity with payer portals such as Availity, NaviNet, and/or ePACES. Strong ability to research and resolve billing and payment issues independently. Working knowledge of HIPAA compliance and patient-data confidentiality. Strong attention to detail and accuracy. Ability to work independently in a remote environment. Excellent written and verbal communication skills. Reliable internet connection and computer equipment suitable for remote work. Ability to work the required Eastern Time schedule. Highly Preferred Experience CareCentrix experience, particularly DME billing and authorization workflows. Blue Cross Blue Shield of New Jersey billing experience through CareCentrix. Brightree experience, particularly AR and collections cleanup. NikoHealth experience. Direct experience with New York Medicaid/ePACES. Respiratory equipment or enteral billing experience. Experience working with calorie counts and unit-based billing. Experience resolving difficult or delayed payer authorizations. Previous experience working with DME/HME, home healthcare, or medical equipment providers. Ideal Candidate The ideal candidate is an experienced RCM professional who can hit the ground running rather than require extensive training. They should understand the complexities of DME and respiratory billing, be comfortable navigating difficult payer systems, and have the judgment to independently identify what needs to be corrected, followed up on, or escalated. This person should be highly organized, persistent with outstanding accounts, comfortable working through complicated authorization requirements, and capable of managing multiple revenue-cycle priorities without constant supervision. Schedule & Work Environment Full-Time Remote Eastern Time (ET) business hours Schedule may be fixed or flexible based on Pinnacle Healthcare's operational needs Primarily back-office/administrative work with occasional insurance-company calls HIPAA-compliant work environment required Success in This Role Success will be measured by the candidate's ability to: Maintain accurate and timely billing. Reduce outstanding and aging AR. Resolve legacy accounts and collections issues. Keep Medicaid and other payer authorizations current. Successfully navigate difficult payer portals and workflows. Reduce billing errors, denials, and payment delays. Work independently with minimal supervision. Transition effectively between Brightree and NikoHealth workflows. Become productive after only a brief onboarding period. Requirements Required Qualifications Proven experience in revenue cycle management, medical billing, or healthcare billing. Hands-on experience with DME and/or respiratory billing. Strong understanding of Medicare billing requirements, modifiers, and diagnosis pointers. Experience with Medicaid, preferably New York Medicaid. Experience managing insurance authorizations and recurring authorization requirements. Experience with accounts receivable, aging reports, denied claims, and collections. Familiarity with payer portals such as Availity, NaviNet, and/or ePACES. Strong ability to research and resolve billing and payment issues independently. Working knowledge of HIPAA compliance and patient-data confidentiality. Strong attention to detail and accuracy. Ability to work independently in a remote environment. Excellent written and verbal communication skills. Reliable internet connection and computer equipment suitable for remote work. Ability to work the required Eastern Time schedule. Highly Preferred Experience CareCentrix experience, particularly DME billing and authorization workflows. Blue Cross Blue Shield of New Jersey billing experience through CareCentrix. Brightree experience, particularly AR and collections cleanup. NikoHealth experience. Direct experience with New York Medicaid/ePACES. Respiratory equipment or enteral billing experience. Experience working with calorie counts and unit-based billing. Experience resolving difficult or delayed payer authorizations. Previous experience working with DME/HME, home healthcare, or medical equipment providers.