Revenue Cycle Specialist – URGENT

As a Revenue Cycle Billing Specialist, you will serve as a bridge between the billing department and third-party payers to resolve overdue claims and collect payments. In this role, you will be responsible for ensuring accurate billing and efficient collections processes within our healthcare organization. This position will report to the Director of RCM Operations.

Essential Duties and Responsibilities

• Prepare, submit, and process initial medical claims in compliance with payer regulations, medical authorizations, and departmental guidelines.
• Monitor accounts to identify overdue payments, ensuring timely follow-up and resolution of outstanding balances.
• Correct errors in previously submitted claims and proactively address initial claim submission issues to secure full payment.
• Clearly communicate with team members, third-party payers, and customers regarding claim errors and submission requirements via phone and email.
• Identify, analyze, and research trends in claim rejections, partial payments, and denials to develop resolution strategies.
• Prioritize tasks to process initial claims efficiently and address denials in a timely manner to prevent timely filing limitations.
• Leverage reporting tools to conduct data analysis and create targeted action plans for improving billing accuracy and efficiency.
• Utilize coding systems (CPT, ICD-10) to ensure accurate claim submission, billing, and collections.
• Reprocess denied or rejected claims as needed to maximize reimbursement.
• Assist with special projects related to accounts receivable (AR) at the direction of the Director of RCM Operations.

Experience and Skills

Minimum of 2 years of experience in medical billing and collections
Experience working with third-party payers, such as VA, Medicaid, Medicare Advantage, and Worker’s Compensation
Experience with revenue cycle management
Experience working with UB04 and HCFA 1500 forms
Familiarity with Electronic Medical Record (EMR) systems
Knowledge of health care collections procedure codes and techniques
Proficiency in using billing software (Clearinghouse) and electronic health records (EHR)
In-depth knowledge of healthcare billing codes (CPT, ICD-10)
Proven success in reducing accounts receivable and improving collections
In-depth knowledge of HIPAA compliance
Excellent follow-up, time management, and communication skills required
Familiarity with PowerBI, Jira, and HubSpot preferred
Proficiency in MS Office Suite (Outlook, Word, Excel) required

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