Job Title: Revenue Cycle Management Specialist I Reports to: Revenue Cycle Manager Accountable to: Senior Director of Revenue Cycle Management Schedule: Monday–Friday, standard business hours FLSA Status: Non-Exempt Position Type: Part-Time Work Setting: Remote Position Overview: The Revenue Cycle Management (RCM) Specialist I performs foundational revenue cycle functions including claim follow-up, denial resolution, payment review, account research, and payer communication. This role supports timely claim resolution, accurate reimbursement, and departmental workflow needs. The Specialist I demonstrates working knowledge of revenue cycle processes while maintaining productivity, accuracy, and compliance standards. This position collaborates with team members to support overall departmental operations and contributes to a high-performing revenue cycle team. The Specialist I builds core skills needed for advancement into more complex revenue cycle responsibilities. Leadership & Team Expectations: • Model professionalism and accountability in all interactions • Communicate clearly and respectfully with payers, team members, and supervisors • Collaborate effectively to resolve account issues and support team workflows • Uphold Heritage’s mission and values in all work performed • Demonstrate reliability by consistently meeting productivity, quality, and attendance expectations • Engage in learning and skill development to support growth within the department Core Responsibilities Include: Claim Follow-Up & Resolution • Review and follow up on outstanding claims to ensure timely processing and reimbursement • Research and resolve claim issues, discrepancies, and payer requests • Submit corrected claims, appeals, or additional documentation as required • Communicate with payers to clarify claim issues and obtain resolution • Monitor claim status and ensure timely follow-up until payment or final determination Payment Review & Account Research • Review payments for accuracy and identify incorrect adjustments • Conduct account research to determine next steps for unresolved claims • Document all actions clearly and accurately in the appropriate systems Documentation & Compliance • Maintain accurate documentation for all account activity • Ensure compliance with billing regulations, payer requirements, and internal policies • Protect PHI and follow all HIPAA standards at all times • Save all work files to the shared R: Drive in accordance with data security requirements Team Support & Workflow • Assist with workflow needs and process updates as directed • Support team communication and coordination • Perform other duties as assigned consistent with this role Performance Expectations / What Success Looks Like: The Revenue Cycle Management Specialist I will be successful in this role when: • Claims are followed up on promptly and resolved efficiently • Documentation is accurate, complete, and timely across all accounts • Denials are reduced through effective follow-up and corrective action • Team members view this person as reliable and communicative • Productivity and quality standards are consistently met or exceeded • Remote work expectations are consistently met, including responsiveness, workspace compliance, and availability Knowledge, Skills and Abilities: Knowledge of: • Revenue cycle processes including claim follow-up, denial management, and payment review • Basic payer rules, denial types, and insurance processes • HIPAA regulations and PHI protection requirements • Electronic health record (EHR) or billing system fundamentals Skills and Abilities: • Strong written and verbal communication skills with payers and internal teams • Ability to problem-solve and research account issues independently • Strong organizational skills and attention to detail • Ability to work independently and meet productivity expectations in a remote environment • Ability to manage competing priorities in a fast-paced workflow Education and Experience: Required: • High school diploma or equivalent • Experience in revenue cycle, medical billing, accounts receivable follow-up, or denial management • Demonstrated ability to meet productivity and quality expectations Preferred: • Experience in behavioral health or community health settings • Familiarity with Medicaid, Medicare, and commercial payers • Experience with EHR or billing platforms such as Netsmart, Epic, or similar Note: Equivalent combination of education and experience will be considered. Physical Requirements and Working Conditions: • Ability to sit and work at a computer for extended periods • Reliable high-speed internet connection required • Must maintain a private, secure, and HIPAA-compliant remote workspace free from interruptions • Ability to maintain focus and productivity in a remote environment • Must follow all Heritage remote work, HIPAA, and data security requirements