RCM AR Specialist

POSITION DESCRIPTION

Position Title: RCM AR Specialist Supervisor’s Title: Director of RCM

Program or Dept: Revenue Cycle Management (RCM) Location and Cost Center: 90-1901

HQ- Glenwood Ave., Raleigh NC

Supervisory Position: No

Job Code: ARSPECIA FLSA Status: Non-Exempt 

Management reserves the right to assign or reassign duties and responsibilities to this job at any time.

The RCM AR Specialist supports the Revenue Cycle Management (RCM) team by performing timely and accurate follow‑up on outstanding claims, denials, and unpaid balances. This role researches issues impacting payment, collaborates with internal departments and funding sources, and ensures all potential revenue is captured and billed. The AR Specialist contributes to denial management, charge entry accuracy, and resolution of aging accounts to support overall revenue cycle performance.

• Researches outstanding balances and completes required follow‑up within established timelines.
• Coordinates with program staff on insurance verification, eligibility, authorizations, and documentation needed for claim resolution.
• Communicates with funding sources regarding denied, underpaid, or outstanding claims.
• Provides ongoing root cause analysis and trend feedback to RCM Management.
• Supports analytical reporting and special assignments as requested.
• Collaborates with programs to review and reconcile program‑related denials.
• Assists programs in managing Unbilled and Violation Reports.
• Performs other administrative tasks as assigned.

• Works with programs to ensure all potential revenue is captured and billed.
• Identifies and bills secondary and tertiary insurance, including rebilled, replaced, and voided claims.
• Works in applicable systems to correct and process claims requiring adjustment or resubmission.

• Participates in root cause analysis to identify trends affecting claim submission and payment.
• Provides feedback on recurring issues impacting billing accuracy or reimbursement.

• Manages all rejections and denials, including review, reconsideration, and resolution.
• Reviews and resolves aging accounts.
• Posts co‑pays, deductibles, co‑insurance, and claim adjustments.
• Resolves claim issues related to re‑adjudications, transfers, recoupments, voids, and retro‑Medicaid rebills.

• High School Diploma or GED required.
• Knowledge of North Carolina Medicaid, LME/MCO, and commercial payer billing rules and regulations.
• Minimum of one (1) year of experience in healthcare or behavioral health billing, claims processing, or accounts receivable.
• Ability to analyze and interpret issues in billing, data collection, and accounts receivable.
• Strong organizational skills and attention to detail.
• Ability to identify problems, gather relevant information, and determine root causes.

• Ability to generate ideas that improve processes and identify connections across workflows.
• Demonstrated professionalism and ability to handle confidential information appropriately.
• Valid unrestricted North Carolina driver’s license, reliable transportation, and current vehicle insurance.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to use a computer for extended periods of time and be able to communicate using a computer and phone/smart device. The employee frequently is required to sit and reach, and must be able to move around the work environment.
• Must possess the visual acuity to develop written correspondence and determine accuracy, neatness and thoroughness of the work assigned.
• Must be able to work in a shared office environment while displaying respect and professionalism toward others in the office.