Revenue Cycle Account Specialist

About the Role:

The Account Specialist plays a critical role in supporting a designated caseload of home care providers to
ensure timely, accurate decisions regarding third-party billing. In this role, you will act as a trusted partner
to customers through troubleshooting issues, resolving billing concerns, and proactively monitoring
account health to prevent disruptions. You will leverage analytical tools, collaborate across teams, and
maintain clear communication to drive positive outcomes and an exceptional customer experience. This
position reports to the Manager of Account Management.

Core Responsibilities:

• Process claims in accordance with payer regulations, medical authorizations, protocols, and
  departmental guidelines
• Investigate and resolve claim denials and rejections using payer resources, clearinghouse tools,
  and internal documentation
• Identify, research, and analyze trends in submitted claims to develop actionable resolutions
• Provide timely and professional support via email using a ticketing system to resolve customer
  inquiries
• Assist customers with setup and navigation of billing platforms, software tools, or other program
  features as needed
• Maintain consistent and proactive communication to ensure customers feel informed and
  supported
• Monitor overall account health, including authorization expirations, clearinghouse rejections, aging
  reports, and payer trends
• Utilize Power BI and other reporting tools to analyze data, uncover discrepancies, and build action
  plans for issue resolution
• Document all updates and interactions thoroughly within the CRM to ensure continuity and reduce
  repeat inquiries

Experience and Skills:

• Minimum 2 years of experience in revenue cycle management (RCM), healthcare billing, or
  related functions with emphasis on third-party payer claims
• Proficiency with CRM systems (HubSpot preferred) and billing software
• Strong written and verbal communication skills with professional business etiquette
• Excellent time management, organization, and follow-up skills
• Demonstrated problem-solving and decision-making abilities
• Experience with project management or leading process improvements
• Familiarity with analytical tools such as Power BI or similar reporting platforms
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel)