RCM Denials & Payor Compliance Specialist

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 reputed company 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 Apply To This Job .