Revenue Cycle Management Specialist (RCMS)^® certification

A Revenue Cycle Management Specialist holds a mid-level position that is responsible for understanding the healthcare revenue process life cycle. The role consists of analyzing and improving current processes, while evaluating the need for new process implementation. The processes include having a global understanding from patient access, authorization through the administrative process of clinical documentation improvement, coding, billing, operations, and back-end processes.

Revenue Cycle Management Specialists must have strong communication skills, understand how to research newly published and/or changing regulations and guidelines, and be able to create synergy by integrating departmental processes to improve the financial stability of the facility or office.

By earning the RCMS credential, you can show employers you are equipped with all the needed skills and knowledge required to be successful in this role.

Competencies proven with RCMS credential

• Collects, interprets, and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve optimal performance, KPIs, and budgetary goals 

• Accurately apply and justify coding and billing conventions when processing the claims 

• Understanding of compliance, including guidelines, laws and regulations across the revenue cycle work flow 

• Understand and apply best practices of reimbursement and collections processes within the revenue cycle 

• Understand the responsibility for establishing new charges, maintaining existing charges, including CPT^®, HCPCS, pricing, fee Charges, schedules, cost centers, revenue codes, strategic pricing, and code updates for hospital/facility and professional charges 

• Knowledge of specific health records requirements and resources such as the LCDs and NCDs

• Ability to interpret the case analysis for denied claims 

• Knowledge of the standards for minimum data specifications for claims, enrolled data, codes, admission, and discharge specialty reference codes 

• Review, analyze, and optimize payer contracts to maximize reimbursement (payer policies, etc.) 

• Clear understanding of patient access, patient demographics in order to support clean claim submission and quality patient care

• Utilize reports in order to monitor patient success, SDoH, patient access, utilization, patient follow-up, identifying patients that need to be seen, quality reporting, readmissions, etc. 

• Clear understanding of denials management including the ability to identify and address underlying causes of denials, implement automated denial tracking and resolution systems, train staff to understand and address common denial reasons 

• Understand the significance of clean claim submissions in quality improvement 

• Understand, implement and monitor scheduling activities in order to provide quality care

• Ability to lead the CDM team in the use and accountability of System work queue functionality, to contribute to clean claims and monitor internal controls that ensure compliance with charging regulations

About the RCMS exam

The RCMS examination consists of questions regarding revenue management processes, standards, and compliance requirements in order to implement, improve, and sustain a compliant and healthy revenue cycle.