Senior RCM Billing Specialist

and the job listing Expires on March 4, 2026

The Senior RCM Billing Specialist is responsible for timely and accurate submission of claims to payers, ensuring compliance with state, federal, and payer‑specific requirements under both Fee‑for‑Service (FFS) and CCBHC billing models, as well as commercial payers. This role prepares and submits claims, works edits, follows up on rejections, and ensures Trilogy’s billing processes run efficiently. The Senior RCM Billing Specialist collaborates with authorization, credentialing, collections, and revenue integrity staff to ensure claims are submitted cleanly and payments are not delayed.

• Audit claims, charge capture, and billing workflows for accuracy and compliance.
• Review all behavioral health billing manuals and provider manuals regularly; communicate updates to leadership.
• Collaborate with clinical staff to ensure documentation supports billing requirements; provide education when needed.
• Monitor rejection trends, elevate systemic issues, and recommend solutions.
• Partner with Billing & Collections Supervisor and Network Administrator to keep EMR fee schedules and codes current.
• Ensure all new payer billing processes are correctly configured and tested in the clearinghouse prior to claim submission.
• Support payer audits, compliance reviews, and special projects.
• Attend payer webinars, provider calls, and training sessions to stay up to date on policy changes, billing requirements, and compliance updates; communicate updates to leadership.
• Develop recommendations for reducing rejections and denials to improve revenue capture.
• Maintain and update documentation of billing workflows.
• Perform other duties and projects as assigned.

• Bachelor’s degree in Finance, Psychology, Social Work, Counseling, Behavioral Health, or other closely related field highly preferred.
• Minimum 7 years of experience in the healthcare industry (particularly Medicaid and Managed Medicaid insurance companies).
• Minimum of 3 years of Healthcare Revenue Cycle Management billing experience, preferably in a behavioral health setting.
• Minimum of 5 years with ICD‑10 coding. Billing and Coding certification is required.
• Prior experience with Lean Six Sigma and Process Improvement methodology preferred.
• Experience with Care Logic/qualifacts system preferred.
• Experience billing through a clearinghouse, such as Inovolan highly preferred.
• Strong understanding of Microsoft applications; i.e. Excel, Outlook, Access, Word.
• Ability to investigate problems and develop/communicate solutions.
• Excellent oral, written, and interpersonal communication skills with a focus on customer service.
• Ability to meet deadlines; highly detail‑oriented; strong financial analysis and organizational skills; and analytical mindset with intellectual curiosity.
• Ability to act and operate independently with minimal supervision.
• FREE Virtual Primary Care, Urgent Care, and Mental Health Counseling for ALL Employees.
• PAID Maternity/Paternity leave.
• Medical Insurance (BCBS of IL).
• Vision Insurance.
• Life Insurance.
• Long‑Term & Short‑Term Disability.
• Pet Insurance.
• FSA (Health, Dependent Care, Transit).
• EAP.
• 403(b) Retirement Plan with Employer Match.