RCM Denials & Payor Compliance Specialist

Job description

Job DetailsJob Location: Remote - Roswell, GA 30076Position Type: Full TimePosition Summary: The RCM Denials & Payor Compliance Specialist is responsible for resolving upheld and complex 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 all billing and payor requirements. Key Responsibilities: Denial Resolution (Primary Focus) Investigate and resolve upheld and complex claim denials across all payors Perform root cause analysis to identify trends and recurring denial drivers Develop and submit appeals, reconsiderations, and supporting documentation Collaborate with clinical, intake, and billing teams to obtain necessary information for resolution Maintain tracking of high-dollar and aged denial cases through resolution Payor Guidelines & Compliance: Act 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...