RCM Operations Specialist

The Opportunity

We are seeking a RCM Operations Specialist to join our growing team and support Homeward’s External Provider Transformation efforts. This individual will play a critical role in reviewing, auditing, and analyzing clinical documentation from external provider partners, ensuring accurate and complete coding of conditions.

You will work alongside our manager to translate chart insights into feedback that improves documentation quality, supports proper reimbursement, and 

This is an ideal role for a proactive, detail-oriented coder with deep knowledge of multiple specialties, exceptional judgment, and experience supporting external practices or provider networks.

• Revenue Cycle Support
  • Support the core functions of mid and end revenue cycle. Coding professional and facility charges. CMS-1500 and UB-04 claim generation and submission. A/R claim follow up investigations and denial management resolution for our rural hospital clients. 
  • The opportunity to work with the latest AI technologies to help you complete various RCM functions.
  • Maintain quality and productivity standards for the core functions ensure optimal operation and A/R for client success. 
  • Ensure timely reimbursement to reduce days in A/R (Accounts Receivable).
• Denial Investigation & Resolution 
  • Analyze and resolve denied/rejected claims, including, but not limited to, referrals, authorizations, and medical necessity.
  • Contact insurance representatives to determine denial reasons and follow up on claim status. 
  • Review denial patterns to identify root causes and implement prevention strategies.
  • Draft and submit appeals to insurance companies (commercial/government) for denied services.
• Collaboration & Enablement Support
  • Collaborates with management, clinic staff, and RCM teams to ensure proper billing and collection procedures.
  • Help shape internal workflows and dashboards that scale denial management effectiveness across the Provider Transformation program.
• Special Projects 
  • Participate in and lead special projects related to coding, billing, and denial management such as new service line implementation.

• 2+ years in medical billing, coding, or revenue cycle management or experience in related fields required. 
• Strong understanding of insurance coding, billing, and denial management resolution techniques including Medicare, Medicaid and commercial insurance plans
• Able to Identify and implement improvements to billing, coding, and payment posting workflows to enhance efficiency.
• Knowledge of regulations: Working knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.
• Proven capability to work independently, prioritizing workload, and managing tight review timelines.
• One or more of the following: Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), Revenue Cycle Management Specialist (RCMS), Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Professional (CRCP), Certified Revenue Cycle Specialist (CRCS), Certified Outpatient Revenue Cycle Manager (CORCM)

• Experience working with Rural Health Care, Critical Access Hospitals, or small hospitals. 
• Background working with external provider groups or vendor-contracted practices.
• Experience working in any other areas of RCM (patient registration, prior authorization, eligibility and benefits, charge capture, payment posting, insurance & claim follow-up, or patient payments & delinquent accounts.
• Experience with CPSI/TruBridge, eClinicalWorks, or Cerner. 

• Deep commitment to one another, the people and communities we serve, and to care that enables everyone to achieve their best health
• Compassion and empathy
• Curiosity and an eagerness to listen
• Drive to deliver high-quality experiences, clinical care, and cost-effectiveness
• Strong focus on sustainability and scalability of our services
• Nurturing a diverse workforce with a wide range of backgrounds and points of view
• Taking our mission seriously - but not ourselves too seriously; we have fun as we build

• Competitive salary
• Paid Time Off
• 11 company paid holidays & 2 personal holidays
• 100% of employee premiums covered for medical, dental & vision insurance
• Company-sponsored 401k plan
• Ongoing professional development opportunities

The base salary range for this position is $26 - $34 hourly. Compensation may vary outside of this range depending on a number of factors, including a candidate’s qualifications, skills, location, competencies and experience. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work at Homeward Health. This role is eligible for an annual bonus, stock options, as well as a comprehensive benefits package.

At Homeward, a diverse set of backgrounds and experiences enrich our teams and allow us to achieve above and beyond our goals. If you have yet to gain experience in the areas detailed above, we hope you will share your unique background with us in your application and how it can be additive to our teams.
Homeward is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Homeward is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.