RCM Specialist

Spillway Workforce Solutions is a staffing and business solutions company with clients in the United States and the United Kingdom.

We are looking for a detail-oriented Revenue Cycle Management (RCM) Specialist to support our healthcare operations. The role involves managing the full cycle of medical billing, from claim submission to payment posting, accounts receivable follow-up, and denial management.

Key Responsibilities

• Prepare and submit accurate and timely insurance claims (government and commercial payers).
• Post and reconcile payments from ERAs and EOBs to the correct patient accounts.
• Follow up on unpaid or denied claims, resubmit corrected claims, and file appeals when necessary.
• Generate and send patient statements for outstanding balances; assist patients in understanding their bills and insurance coverage.
• Collaborate with coders and providers to ensure accurate use of CPT, ICD-10, and HCPCS codes.
• Monitor denial trends, analyze root causes, and implement corrective measures to minimize rejections.
• Conduct periodic audits to ensure compliance with HIPAA, Medicare/Medicaid, and payer regulations.

Ideal Candidate Must Have:

• 2+ years of experience in medical billing, accounts receivable, or revenue cycle management.
• Strong knowledge of CPT, ICD-10, and HCPCS codes.
• Familiarity with ERA/EOB processing and claim submission software.
• Experience handling denial management and payer follow-ups.
• Strong communication skills for both payer and patient interactions.
• High attention to detail and ability to work independently.
• Prior experience with US healthcare systems required.