RCM AR Specialist: Denials & Revenue Capture

Easterseals PORT Health; Raleigh (NC); On-site; USD 2,893,000 - 3,237,000; Full time

Benefits offered by this job

Competitive pay

Generous paid time off

Full benefits package

Life and disability insurance

401(k) retirement plan with company 2x

PSLF eligible employer

Job summary

Easterseals PORT Health is seeking an RCM AR Specialist Supervisor in Raleigh to support the Revenue Cycle Management team by following up on outstanding claims, denials, and unpaid balances. You will research issues, collaborate with internal departments, and help ensure revenue is captured and billed.

This role emphasizes denial management, charge entry accuracy, and aging account resolution, with a focus on NC Medicaid, LME/MCO, and commercial payer billing rules.

Qualifications

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

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 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

Denial management

Billing accuracy

Data analysis

Organizational skills

Detail oriented

Problem solving

Education

High School Diploma or GED

Tools

Billing systems

Job description

Easterseals PORT Health is seeking an RCM AR Specialist Supervisor in Raleigh to support the Revenue Cycle Management team by following up on outstanding claims, denials, and unpaid balances. You will research issues, collaborate with internal departments, and help ensure revenue is captured and billed.

This role emphasizes denial management, charge entry accuracy, and aging account resolution, with a focus on NC Medicaid, LME/MCO, and commercial payer billing rules.