Medical Billing & Claims CSR I Revenue Cycle Management Specialist

The RCM Senior Associate is responsible for overseeing a broad range of duties within the revenue cycle management process, ensuring accurate and timely claims and billing submission, denial and appeals processing, reconciliation, and KPI monitoring. This role focuses on optimizing revenue collection through clean claim submission, A/R follow-up, collections, and management of medical accounts, as well as supporting month-end closing, audits, and compliance across multiple states and insurance carriers.

Key Responsibilities:

Receive, record, and reconcile charges from daily client services.

Prepare and submit clean claims and billings via electronic and paper channels.

Track claim submissions, resolving pre-bill edits and rejections promptly.

Issue adjusted, corrected, or rebilled claims to insurance companies.

Manage denials, appeals, and accounts receivable follow-up to ensure timely reimbursements.

Coordinate and execute mass appeals with multiple payors.

Review payer and client accounts, recommending actions for non-collectible balances.

Maintain up-to-date knowledge of payer reimbursement guidelines.

Identify and resolve discrepancies and errors through adjustments, cash application updates, or corrective actions.

Review, process, and endorse patient and payer refunds with proper documentation.

Ensure accurate transfer of RCM transactions to reporting platforms for revenue and AR recognition.

Prepare, distribute, and analyze KPI reports and month-end revenue summaries.

Respond to insurance carrier inquiries promptly.

Request updates to RCM master data as needed.

Foster teamwork, professionalism, and critical thinking in all tasks.

Deliver exceptional customer service.

Perform other related duties as assigned.