[Hiring] RCM Specialist I @Paradigm Oral Surgery

Role Description

The RCM Specialist I is an individual contributor role on the RCM team, responsible for front-end and mid-cycle revenue cycle tasks with a primary focus on insurance verification, claim submission, and customer service. This role ensures accurate eligibility and benefit gathering across dental or medical payers, clean pre-authorization and claim generation, timely insurance processing, and a positive experience for patients and supported offices. The ideal candidate has a working knowledge of dental and medical billing processes, is detail-oriented, and is committed to delivering excellent service to both internal stakeholders and patients.

Key Responsibilities

• Perform all assigned RCM activities in accordance with best practices and internal SOPs.
• Verify insurance coverage and benefits for scheduled patients using payer portals or phone calls.
• Accurately enter and update insurance information in the practice management system.
• Confirm eligibility, plan limitations, and coordination of benefits to ensure claims are submitted cleanly in the appropriate billing order.
• Submit pre-determination and pre-authorizations requested by the patient or supporting practices with all necessary clinical attachments, follow-up on processing status, and notify practice of status return in a timely manner ensuring treatment is not delayed.
• Prepare and submit claims (electronic, paper, or via portal) in accordance with payer-specific requirements and timelines.
• Review rejected claims, identify causes, and resubmit corrected claims as needed.
• Respond promptly and professionally to patient and office inquiries related to billing, insurance coverage, and balances.
• Assist in creating and sending patient statements and following up on outstanding balances as directed.
• Document all insurance verification results, pre-authorization and claim submissions, and patient interactions thoroughly and clearly.
• Escalate issues related to claim delays, system errors, or patient concerns to the appropriate RCM team members or supervisors.
• Maintain compliance with HIPAA, payer guidelines, and internal policies.
• Participate in team meetings and training sessions to stay current on processes, tools, and payer updates.
• Support other RCM functions as needed to ensure a smooth and efficient revenue cycle process.
• Support RCM management in understanding and self-identifying contributing factors to site-specific RCM KPIs, highlighting areas of concern and areas for improvement.

Essential Qualifications

• Prior experience in Dental Office workflows, Revenue Cycle functions including Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow-up, and payment posting process.
• Knowledgeable of reimbursement/compliance processes and procedures with all payors.
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, and proficient in intermediate PC skills (MS Office—strong Excel skills).
• Strong computer literacy, excellent math and problem-solving skills, data entry, and 10-key by touch.
• Strong interpersonal and organizational skills; ability to work within a team setting and as an individual contributor.
• Excellent oral and written communication skills.
• Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures.
• Organized work habits, accuracy, and proven attention to detail with strong analytical skills.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred.