Revenue Cycle Specialist

Position Summary

The Revenue Cycle Specialist (RCM Specialist) serves as the central point of coordination for all revenue cycle activities at Andrews ASC, ensuring timely, accurate, and compliant billing and collections. This role bridges clinical, administrative, and financial workflows to support efficient claim lifecycle management—from scheduling through payment. The ideal candidate brings knowledge of ASC billing, strong attention to detail, and a proactive, team-centered mindset.

Key Responsibilities

Revenue Cycle Oversight

· Coordinate charge capture, coding integrity, and claim submission processes.

· Monitor clearinghouse rejections and manage timely resolution of claim edits.

· Review and maintain accurate claim aging, payment status, and denial trends.

Denial Management & A/R Follow-Up

· Investigate and resolve claim denials in collaboration with billing vendors and payers.

· Escalate recurring issues and identify payer or documentation trends that impact reimbursement.

· Maintain accurate records of appeals, follow-up efforts, and outcomes.

Authorization & Verification

· Collaborate with Scheduling and Clinical teams to ensure proper insurance verifications and prior authorizations are in place.

· Track surgical authorizations and identify missing documentation pre-op.

Clinical & Administrative Collaboration

· Partner with surgeons, coders, and clinical documentation staff to ensure op notes support billed procedures.

· Support education and process improvement for front-end revenue integrity (e.g., registration, demographics, insurance entry).

Reporting & Communication

· Prepare and distribute daily, weekly, and monthly revenue cycle performance reports.

· Assist in tracking KPIs including Days in A/R, Clean Claim Rate, Denial Rate, Net Collections.

· Communicate status updates and risk areas to Finance and Administrative leadership.

Compliance & Documentation

· Ensure compliance with federal and commercial payer rules, including modifier use and billing guidelines specific to ASCs.

· Maintain accurate and up-to-date SOPs for revenue cycle workflows.

Knowledge, Skills & Abilities

· Working knowledge of ASC billing practices, including CPT/HCPCS coding and modifier use.

· Strong organizational, time management, and follow-up skills.

· Ability to communicate effectively with clinicians, payers, and vendors.

· Analytical mindset with the ability to interpret trends in A/R and denials.

· Comfortable using EMR, practice management, and clearinghouse systems.

· Ability to maintain confidentiality and handle sensitive information with discretion.

· All other duties as assigned.

Qualifications

· Minimum 3 years of experience in medical billing, claims follow-up, or RCM coordination (ASC experience strongly preferred).

· Familiarity with CMS guidelines, commercial payer requirements, and industry best practices.

· Proficient in Microsoft Excel, Outlook, and claims management platforms.

· Strong verbal and written communication skills.

Preferred Qualifications

· Bachelor’s degree in Business Administration, Healthcare Management, or related field.

· Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or CPC certification.

· Experience with surgical coding or charge entry for orthopedics, spine, or pain management procedures.

· Understanding of ASC-specific reimbursement models and payment structures.

Working Conditions

On-site role in a fast-paced surgical center environment.

May require occasional extended hours to meet month-end or audit deadlines. 

Collaborates closely with multiple departments, including Registration, Scheduling, Finance, and Clinical Services.

Employment Type

Full-Time / Hourly

**ANDREWS IS A TOBACCO FREE WORKPLACE**

The Andrews Institute ASC (AIASC) is committed to promoting health, wellness, and disease prevention and to providing a safe, clean and healthy environment to Workforce Members, patients, and visitors. The use of tobacco and tobacco products is a known and established hazard to the health and well-being of tobacco users and can also directly impact nonusers. In addition, the use of tobacco and tobacco products has been shown to decrease employee productivity and efficiency and increase absenteeism. In recognition of these factors, the Andrews Institute ASC will no longer hire tobacco users.