RCM Specialist- Acute Authorization Oversight presso 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 – Acute Authorization Oversight is responsible for coordinating and enhancing the insurance authorization process for inpatient, emergency, surgical, and specialty acute care services. This role plays a key part in safeguarding revenue integrity and ensuring smooth patient access by facilitating timely and accurate submission of authorizations, monitoring compliance with payer medical necessity guidelines, and evaluating internal and vendor performance.

Serving as a liaison between clinical teams and payers, the RCM Specialist identifies and resolves authorization-related barriers to care, provides education to stakeholders, and helps reduce avoidable denials through data analysis and workflow improvements.

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 revenue cycle (CRCR), medical billing/coding (e.g., CPC), or related field 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:

• In-depth knowledge of payer authorization requirements and medical necessity criteria for acute services.
• Proficiency with EMR and payer authorization systems (e.g., Epic, Cerner, or similar).
• Excellent written and verbal communication skills.
• Strong critical thinking and problem-solving abilities.
• Ability to collaborate effectively with interdisciplinary teams, including clinical and non-clinical staff.
• High attention to detail and strong organizational skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook).

Work Experience:

• Minimum 3–5 years of healthcare authorization, insurance verification, or revenue cycle experience.
• Experience working with payer requirements specific to acute inpatient, emergency, and surgical services preferred.
• Prior experience working with third-party vendors and EMR/authorization platforms.

ESSENTIAL FUNCTIONS:

• Review and validate inpatient, emergency, and surgical authorizations to ensure accuracy, completeness, and timeliness.
• Monitor payer authorization guidelines and ensure adherence to current medical necessity standards.
• Serve as a liaison with clinical departments including ED, surgery, oncology, and rehabilitation to prevent service delays due to authorization issues.
• Audit authorization submissions by internal teams and third-party vendors; ensure timely turnaround and accuracy.
• Identify trends in denials or delayed authorizations and escalate findings to leadership with recommended solutions.
• Develop and maintain standard workflows and staff education materials to promote compliance and efficiency.
• Provide performance reports and metrics related to acute authorizations to leadership and other stakeholders.
• Support continuous process improvement efforts and contribute feedback to enhance patient access and revenue cycle outcomes.
• Maintain a working knowledge of payer policy updates and communicate changes to relevant teams in a timely manner.

NON-ESSENTIAL FUNCTIONS

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