Revenue Cycle Specialist

Overview

The Revenue Cycle Specialist is responsible for managing the full cycle of medical billing and collections to ensure accurate claim submission, timely payments, and compliance with regulatory guidelines. This role plays a critical part in maintaining the financial health of the organization by overseeing claim accuracy, resolving denials, and supporting credentialing and payer-related functions. This is a in office position.

Duties

• Prepare, review, and submit clean insurance claims through electronic and paper submission methods.
• Verify patient insurance coverage and eligibility, obtaining prior authorizations as required.
• Monitor claim status, follow up on unpaid or denied claims, and appeal when necessary.
• Post payments, adjustments, and denials accurately into the practice management system.
• Research and resolve billing issues, credentialing discrepancies, and payer rejections.
• Maintain up-to-date knowledge of payer policies, billing codes, and compliance requirements.
• Assist with provider enrollment, credentialing updates, and contract maintenance.
• Generate and review aging reports, proactively working to reduce outstanding balances.
• Communicate with providers, staff, and insurance representatives to resolve revenue cycle concerns.
• Support process improvement initiatives to optimize reimbursement and reduce errors.
• Maintain confidentiality of patient health information in compliance with HIPAA.

Qualifications

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
• Minimum 4 years of experience in medical billing, collections, or revenue cycle management, behavioral health is a plus
• Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding.
• Knowledge of payer requirements, credentialing processes, and prior authorization workflows.
• Proficient in practice management and electronic health record (EHR) systems.
• Excellent organizational, problem-solving, and follow-up skills.
• Strong communication skills with the ability to work independently and in a team.

Core Competencies:

• Attention to detail and accuracy.
• Strong analytical and investigative skills.
• Ability to manage competing priorities in a fast-paced environment.
• Commitment to compliance and ethical standards.

Work Environment:

• Office-based (depending on company policy).
• Standard business hours, with occasional extended hours based on workload.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

This position is essential in supporting our commitment to providing high-quality healthcare services while ensuring that all practitioners meet the required qualifications to deliver safe patient care.