RCM Specialist- Ambulatory Authorization Oversight chez North Country Healthcare

About North Country Healthcare (NCH):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve. As a leader in a management position this role emphasizes advancing High-Reliability Organization (HRO) principles, embedding a culture of safety, accountability, and consistent high performance.

POSITION SUMMARY:

The RCM (Revenue Cycle Management) Specialist – Ambulatory Authorization Oversight is responsible for ensuring timely and accurate insurance authorizations for outpatient clinics, diagnostic services, therapies, and ambulatory procedures. This role plays a critical part in maintaining revenue integrity by overseeing third-party vendor performance, staying current on payer authorization guidelines, and partnering with clinical and administrative teams to reduce claim denials related to authorization errors.

The specialist acts as a key liaison between scheduling, referral, and billing teams, supporting efficient workflows and compliance with payer requirements. The position requires analytical oversight, proactive issue resolution, and education to ambulatory staff on evolving payer protocols.

ESSENTIAL QUALIFICATIONS

Education:

• High school diploma or equivalent required
• Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred.

Certification:

• Certification in medical billing/coding or revenue cycle management (e.g., CRCR, CPC, or equivalent) preferred

Licensure:

• Association* accredited course in Basic Life Support (BLS) (for clinical staff), or Heartsaver CPR AED (for nonclinical staff), and renewal on a regular basis, with up to a three-month grace period after the expiration date.

Skills:

• Strong knowledge of payer-specific authorization processes, especially for ambulatory and diagnostic services
• Familiarity with EMR systems and authorization platforms (e.g., Epic, Cerner, or equivalent)
• Excellent verbal and written communication skills
• Critical thinking and problem-solving ability with a focus on process improvement
• Strong attention to detail and organizational skills
• Ability to work independently and collaboratively with clinical and non-clinical teams
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word)

Work Experience:

• Minimum 3–5 years of experience in healthcare authorization, insurance verification, or revenue cycle operations.
• Experience with payer guidelines for ambulatory and outpatient services strongly preferred.
• Prior experience working with external vendors and payer portals is a plus.

ESSENTIAL FUNCTIONS:

• Monitor and manage the end-to-end authorization process for outpatient and ambulatory services to ensure timely approvals
• Collaborate with scheduling and referral teams to verify that authorizations align with orders and scheduled services
• Audit authorization accuracy from third-party vendors and escalate performance issues as needed
• Track, analyze, and report on authorization-related denial trends; provide root cause analysis and recommend corrective actions
• Educate ambulatory staff and providers on payer authorization requirements and changes to ensure compliance
• Maintain knowledge of current payer policies and guidelines and proactively communicate updates to stakeholders
• Serve as a subject matter expert in authorization workflows, providing support to front-end teams during escalations
• Partner with clinic leadership and revenue cycle teams to optimize workflows and support departmental growth
• Uphold NCH’s commitment to service excellence, regulatory compliance, and financial sustainability

NON-ESSENTIAL FUNCTIONS

• Performs additional duties as assigned.
• Adheres to facility Values, Service Excellence and Standards of Excellence.