End-to-End RCM Specialist: Claims, Denials & Appeals

100Plus; Idaho; Hybrid; USD 18,000 - 21,000; Full time

Job summary

100Plus is seeking an RCM Specialist to manage the full lifecycle of medical claims, from pre-service authorizations to post-submission follow-up. The role requires sharp analytical skills, meticulous data integrity, and the ability to navigate payer portals, clearinghouses, and billing systems efficiently.

The candidate should be experienced in handling 835 remittances, payer denials, and A/R through to resolution, while maintaining compliance with HIPAA and industry standards.

Qualifications

• 3+ years of hands-on medical billing or revenue cycle experience covering both authorization and back-end claim resolution.
• Experience with prior authorization workflows across Medicare, Medicaid, managed care, and commercial payers.
• Proficiency in CPT, HCPCS, ICD-10, modifiers, and medical terminology; read remittance advices (835) and EOBs.

Responsibilities

• Obtain, renew, and extend prior authorizations for services and equipment prior to the date of service; track expiration dates and renewals.
• Verify member eligibility, benefits, coverage dates, and coordination of benefits with payers.
• Validate authorization data on file matches what will be billed and correct discrepancies at the source.
• Prepare, review, and submit clean claims to Medicare, Medicaid, managed care, commercial, and third-party payers.
• Monitor clearinghouse queues daily; work front-end rejections and edits to zero before they age.
• Analyze remittance advice, determine the correct disposition for denials and appeals, and follow up as needed.
• Maintain HIPAA compliance and safeguard PHI; support audits and month-end close.

Skills

Analytical thinking

Detail oriented

Communication skills

Education

High school diploma or equivalent

Associate's or Bachelor's degree in Healthcare Administration/Business/Finance

Tools

Excel

EMR platforms

Job description

100Plus is seeking an RCM Specialist to manage the full lifecycle of medical claims, from pre-service authorizations to post-submission follow-up. The role requires sharp analytical skills, meticulous data integrity, and the ability to navigate payer portals, clearinghouses, and billing systems efficiently.

The candidate should be experienced in handling 835 remittances, payer denials, and A/R through to resolution, while maintaining compliance with HIPAA and industry standards.