RCM Coordinator

About the Role

We are seeking a highly organized and detail-oriented RCM Coordinator to join our Revenue Cycle Management team. This role serves as an operational hub between coding, billing, clinical staff, and payers — coordinating daily RCM workflows, monitoring claim status, resolving front-line issues, and keeping communication flowing so the revenue cycle runs smoothly from patient encounter to payment posting. This is a full-time, on-site role located in our Somerset, NJ office.

Key Responsibilities

Daily Coordination & Communication

• Monitor and manage the shared RCM/billing mailbox daily — triage payer correspondence, denial notices, patient billing inquiries, and internal requests, routing each to the right team member and responding within SLA.
• Serve as the first point of contact for coding, billing, and collections questions from internal clinical and administrative staff.
• Coordinate communication between coders, billers, physicians, nurse practitioners, and payers to resolve documentation gaps or claim holds.
• Maintain and update trackers/logs (claims in process, denials, pending documentation, escalations) and share status updates with the RCM Manager.
• Make outbound calls to patients to verify insurance coverage and update account information as needed.

Claims & Billing Workflow Support

• Track claims through the full billing cycle — submission, clearinghouse acceptance, payer adjudication, denial/appeal, and payment posting.
• Review claim edits, rejections, and clearinghouse reports; route corrections to the appropriate coder or biller and follow up to closure.
• Support timely charge entry and claims submission by confirming encounters, documentation, and coding are complete and ready for billing.
• Assist with insurance verification, eligibility checks, and prior authorization tracking as needed.
• Help prepare and distribute daily/weekly RCM reports (claims submitted, denials, AR aging, first-pass acceptance rate).

Denial & AR Follow-Up

• Log and categorize denials, identify trends, and escalate recurring issues to coding, billing, or payer contacts.
• Support timely appeals by gathering documentation, correcting claims, and coordinating resubmission with the billing team.
• Follow up on aged accounts receivable and outstanding payer balances, documenting all activity in the practice management/EHR system.

Compliance & Process Improvement

• Ensure all coordination activities comply with HIPAA, CMS, and payer-specific telehealth billing guidelines.
• Identify workflow bottlenecks and recommend process improvements to reduce denials and improve first-pass acceptance rate (FPAR).
• Maintain accurate, organized documentation and audit trails to support pre-billing and compliance reviews.
• Stay current on payer policy changes, telehealth regulations, and RCM industry best practices.

Required Qualifications

• High school diploma or equivalent required; Associate's degree in healthcare administration, business, or related field preferred.
• 4–6 years of experience in medical billing, revenue cycle, or healthcare administrative coordination (telehealth or outpatient setting a plus).
• Working knowledge of ICD-10, CPT, and HCPCS coding concepts, and payer billing requirements (Medicare, Medicaid, Commercial, CCM, RPM).
• Proficiency with EMR/EHR and practice management/billing software, plus strong Microsoft Office/Outlook skills.
• Excellent written and verbal communication skills; comfortable managing high email and phone volume and cross-team follow-up.
• Strong organizational skills and attention to detail in a deadline-driven RCM environment.
• Ability to multitask, prioritize, and track multiple open items to resolution.

Preferred Skills

• Coding or billing certification (CPC, CBCS, CMAA, or similar) a plus, though not required for this coordinator-level role.
• Experience with denial management, AR follow-up, or pre-billing audit workflows.
• Familiarity with telehealth-specific billing models (CCM, RPM, virtual visits).
• Strong analytical and problem-solving skills; comfortable working independently and collaboratively.