RCM AR Specialist: Denials & Reimbursement Expert

Port Health; Raleigh (NC); On-site; USD 29,000 - 32,000; Full time

Benefits offered by this job

Competitive pay

Paid time off and holidays

Medical, Dental, and Vision benefits

Life and Disability Insurance

403(b) Retirement Plan with company匹

Employee Assistance Program

PSLF qualifying employer

Job summary

Port Health is seeking an RCM AR Specialist to support the Revenue Cycle Management team in Raleigh, NC. You will perform timely follow-up on outstanding claims, denials, and unpaid balances, researching issues impacting payment and collaborating with internal departments to ensure revenue is captured and billed.

The role requires at least 1 year of healthcare billing experience, strong data analysis, and the ability to handle confidential information.

Qualifications

• High School Diploma or GED required.
• Knowledge of NC Medicaid, LME/MCO, and commercial payer rules.
• Minimum of one (1) year of experience in healthcare 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.
• Demonstrated professionalism and ability to handle confidential information appropriately.
• Valid unrestricted North Carolina driver’s license, reliable transportation, and current vehicle insurance.

Responsibilities

• 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.

Skills

Accounts receivable follow-up

Denial management

Charge entry

Data analysis

Attention to detail

Education

High School Diploma or GED

Tools

Billing and claims processing systems

NC Medicaid knowledge

Job description

Port Health is seeking an RCM AR Specialist to support the Revenue Cycle Management team in Raleigh, NC. You will perform timely follow-up on outstanding claims, denials, and unpaid balances, researching issues impacting payment and collaborating with internal departments to ensure revenue is captured and billed.

The role requires at least 1 year of healthcare billing experience, strong data analysis, and the ability to handle confidential information.