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About the Client
A venture-backed virtual pediatric care company is looking for a Revenue Cycle Management Specialist to run day-to-day billing operations and keep insurance reimbursement and patient payments flowing on time.
The company delivers virtual, multi-specialty care for children with chronic conditions such as ADHD and anxiety, with referrals coming from pediatricians across multiple US states. It is in-network with major commercial insurers, serves both commercial and Medicaid families, and recently raised a Series A to expand into new care areas.
About the Role
The RCM Specialist owns the revenue cycle from insurance verification and claims submission through payment posting, claims follow-up, denials, and patient collections, reporting to the Team Lead. The role works directly with patients, families, payers, and internal teams to resolve billing and reimbursement issues. Success means clean claims, faster reimbursement, fewer repeat denials, and a clear billing experience for families.
Core Responsibilities
Eligibility & Benefits Verification
Verify insurance eligibility and benefits before visits, before claim submission, and during follow-up.
Confirm copays, deductibles, coinsurance, out-of-pocket maximums, and in-network status.
Investigate inactive policies, coverage limits, and discrepancies.
Document verification results accurately in designated systems.
Claims Submission
Validate demographics, insurance details, CPT and ICD-10 codes, modifiers, and place of service before submission.
Submit claims within payer timely filing requirements.
Monitor clearinghouse and payer acknowledgments, and correct and resubmit rejected claims.
Route coding questions to the designated reviewer.
Payment Posting
Post insurance payments, adjustments, and denials from ERAs and EOBs.
Post patient payments according to billing and collection procedures.
Reconcile posted payments against deposits and remittance totals.
Flag underpayments and overpayments against expected reimbursement.
Claims Follow-up, Denials & Appeals
Follow up on unpaid, pending, and underpaid claims through payer portals.
Identify denial root causes and complete corrections, resubmissions, reconsiderations, and appeals.
Track denial trends and recovery outcomes, and flag recurring payer, coding, or eligibility issues.
Escalate complex or unresolved claims to the Team Lead.
Patient Billing & Collections
Explain coverage, benefits, and expected costs to patients and families based on verified benefits.
Conduct outreach on outstanding copays, coinsurance, deductibles, and self-pay balances.
Set up payment arrangements within approved guidelines.
Respond to billing inquiries by phone, email, and patient portal.
Documentation & Quality
Document all RCM activity in designated systems following SOPs, payer guidelines, and HIPAA requirements.
Meet assigned productivity, quality, and turnaround-time targets.
Recommend workflow improvements based on recurring billing issues.
Requirements
Must-Have
2+ years of hands-on US healthcare revenue cycle or medical billing experience
Hands-on experience across eligibility and benefits verification, claims submission, payment posting, claims follow-up, and denial management
Working knowledge of US commercial insurance and Medicaid, including copays, deductibles, coinsurance, and network status
Working knowledge of CPT, ICD-10, and modifiers for claim review and validation
Payment posting from ERAs and EOBs, including adjustments, denials, and deposit…