Lead Revenue Cycle Specialist

The Revenue Cycle Specialist is responsible for supporting the organization’s revenue cycle processes from charge capture through payment posting and follow-up. This role ensures accurate billing, timely claims submission, and resolution of insurance and patient account issues to maximize reimbursement while maintaining compliance with all applicable federal, state, and payer regulations. The Revenue Cycle Specialist works collaboratively with clinical, admissions, utilization review, and finance teams to ensure complete and accurate documentation that supports appropriate billing and reimbursement. 

DUTIES AND RESPONSIBILITIES 

Billing and Claims Processing 

• Enter and maintain accurate billing data within the billing system or electronic health record (EHR). 

• Prepare and submit electronic and/or paper claims to insurance carriers in a timely and accurate manner. 

• Review claims prior to submission to ensure completeness and compliance with payer requirements. 

• Monitor claim auto-filing processes and report system errors or billing issues to management. 

Insurance Follow-Up and Collections 

• Monitor outstanding claims and follow up with insurance payers regarding unpaid or delayed claims. 

• Investigate denied or rejected claims and determine the appropriate corrective action. 

• Submit corrected claims or appeals as necessary to ensure proper reimbursement. 

• Work to resolve insurance payment discrepancies, underpayments, or claim denials. 

Patient Billing 

• Generate and distribute patient statements in accordance with organizational policies. 

• Respond to patient billing inquiries and assist with resolution of account issues when appropriate. 

Data Quality and Coordination 

• Work closely with admissions, clinical, and administrative staff to ensure accurate patient demographics, insurance information, and service documentation. 

• Ensure billing information is accurate and consistent across systems to support claim approval and reimbursement. 

Compliance and Confidentiality 

• Maintain compliance with all applicable federal, state, and payer regulations related to healthcare billing and reimbursement. 

• Maintain a thorough understanding of HIPAA privacy and security requirements and protect patient confidentiality at all times. 

• Participate in internal audits or compliance reviews as needed. 

Reporting and Revenue Monitoring 

• Review aging reports and prioritize accounts requiring follow-up to support timely collections. 

• Identify billing or reimbursement trends and report issues to the Director of Revenue Cycle Management. 

• High School Diploma or Equivalent required 

• Associate or bachelor’s degree in healthcare administration, business, finance, or related field preferred. 

• Minimum two (2) years of experience in related field preferred 

• CPR/FA Certification – to be obtained within first 30 days 

• Fingerprint Clearance Card – have current card or show proof of applying within 7 days from hire date 

• Handle with Care – to be obtained within first 30 days 

• Successful clearance of pre-employment criminal/county/state background check 

• Successful clearance of pre-employment drug and alcohol testing 

• Successful clearance of TB PPD testing upon hire and annual screening of TB symptoms 

Additional Notes: 
America’s Rehab Campus’s is an Equal Opportunity Employer, a drug free workplace, and complies with Veteran and ADA regulations as applicable.