Remote RCM Coordinator: Claims & Denial Resolution

Metrocare Services; Hillside (NJ); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Paid Time Off

Paid Holidays

Retirement Plan

Health Savings Account

Professional Development allowance

Bilingual Stipend

Job summary

Metrocare Services is seeking a Remote RCM Coordinator – Claims Resolution to join our Revenue Cycle Management team. This role focuses on ensuring accurate claim submission, payment posting, and denial prevention across primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services.

The position requires advanced payer policy knowledge, experience with Availity/TMHP, and strong analytical/problem-solving skills to safeguard agency revenue while collaborating with clinical and

Qualifications

• High school diploma or GED and at least 5 years of experience in medical billing, claims processing, or revenue cycle management.
• Preferred: Associate degree; knowledge of ICD-10, CPT, HCPCS; familiarity with Medicaid, Medicare, CPB, CRCS, CPC, and commercial insurance requirements.

Responsibilities

• Prepare, review, and submit claims for primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services to Medicaid, Medicare, and commercial payers.
• Monitor claim status and ensure timely acceptance, adjudication, and payment across multiple service lines.
• Research and resolve claim denials, rejections, and underpayments specific to medical, behavioral health, and developmental disability services.
• Partner with clinical and administrative teams to ensure proper coding, documentation, and authorization for services provided.
• Maintain current knowledge of payer policies, rules, and regulatory requirements for mental health, primary care, ABA therapy, IDD, ECI, and LIDDA programs.
• Track denial and rejection trends across all service areas, identify root causes, and recommend corrective action.
• Document claim activity, correspondence, and resolution steps accurately in the billing system.
• Provide reporting and analysis to management regarding claim performance, payer trends, and process improvement opportunities.
• Collaborate with the Revenue Cycle Management team to ensure compliance and revenue integrity across all program areas.

Skills

Analytical skills

Communication skills

Problem solving

Attention to detail

Education

High school diploma or GED

Associate’s degree

CPB certification

CRCS certification

CPC certification

Tools

Availity

TMHP

Clearinghouse portals

Job description

Metrocare Services is seeking a Remote RCM Coordinator – Claims Resolution to join our Revenue Cycle Management team. This role focuses on ensuring accurate claim submission, payment posting, and denial prevention across primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services.

The position requires advanced payer policy knowledge, experience with Availity/TMHP, and strong analytical/problem-solving skills to safeguard agency revenue while collaborating with clinical and