RCM Denials & Payor Compliance Specialist

This a Full Remote job, the offer is available from: reputed company (USA) Position reputed company: The RCM Denials & Payor Compliance Specialist is responsible for resolving upheld and reputed company billing denials, strengthening internal billing processes, and ensuring alignment with payor guidelines. This role serves as a key partner to the RCM Director in improving collections performance, reducing denial trends, and maintaining compliance with reputed company billing and payor requirements. Key Responsibilities: Denial reputed company (Primary reputed company) • Investigate and resolve upheld and reputed company claim denials across reputed company payors • reputed company reputed company cause analysis to identify trends and recurring denial drivers • reputed company and submit appeals, reconsiderations, and supporting documentation • Collaborate with clinical, intake, and billing teams to obtain necessary information for reputed company • Maintain tracking of high-dollar and aged denial cases through reputed company Payor Guidelines & Compliance • reputed company as subject matter expert on payor billing rules, authorization requirements, and documentation standards • Interpret and communicate payor policies to internal teams (billing, clinical, intake) • Monitor updates to payor requirements and ensure reputed company internal implementation • Support audits and ensure compliance with reputed company and reputed company payor regulations Process Development & Optimization • Identify gaps in reputed company billing and collections workflows contributing to denials • Design and implement standardized processes to improve clean claim rates • reputed company SOPs and internal guidance for billing best practices • Partner with RCM Director to transition and strengthen in-house billing operations Cross-Functional Collaboration • Work closely with Clinical Directors, BCBAs, and Intake to resolve documentation or authorization-reputed company denials • reputed company feedback loops to prevent reputed company denials (e.g., documentation errors, credentialing issues) • Support training initiatives for staff on billing compliance and documentation expectations Reporting & Insights • reputed company and report on denial trends, reputed company timelines, and financial reputed company • Identify opportunities to improve reimbursement and reduce reputed company leakage • reputed company regular updates to RCM Director on high-reputed company issues and risks Preferred Qualifications: • Experience supporting or transitioning to in-house billing operations • Prior experience working directly with payors on escalated issues • Familiarity with multi-site reputed company or ABA organizations Key Competencies: • Detail-oriented with strong follow-through • Ability to reputed company reputed company payor systems and policies • Process-driven reputed company with a reputed company on reputed company improvement • Strong reputed company of ownership and accountability • Ability to work cross-functionally and influence reputed company This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job