Revenue Cycle Specialist

Description

Department: Revenue Cycle

Reports To: Billing Supervisor

Job Status: Full-Time

FLSA Status: Non-Exempt

Positions Supervised: None

Position Summary

The Revenue Cycle Specialist supports the Billing Supervisor by performing full-cycle revenue cycle functions to ensure accurate billing, timely collections, and optimal reimbursement. This role is responsible for hands-on execution across the revenue cycle, including charge posting, accounts receivable follow-up, denial management, open encounter resolution, and reporting.

The Revenue Cycle Specialist works closely with the Billing Supervisor, clinical teams, and front office staff to support revenue integrity, compliance, and continuous improvement in a fast-paced healthcare environment.

Essential Duties And Responsibilities

Revenue Cycle Operations

• Perform full-cycle revenue cycle functions, including charge posting, claims submission, payment posting, and accounts receivable follow-up.
• Manage assigned accounts receivable to ensure timely collections and resolution of unpaid or underpaid claims.
• Work open encounters and resolve charge, coding, or documentation issues to ensure accurate and timelybilling.
• Ensure accurate charge capture and alignment between clinical documentation and billing data.
  
  

Denials and Follow-Up

• Identify, research, and resolve claim denials, rejections, and underpayments across all payers.
• Prepare and submit appeals and corrected claims as appropriate.
• Escalate recurring or complex denial issues to the Billing Supervisor with supporting analysis.
  
  

Reporting and Analysis

• Run and review revenue cycle reports, including AR aging, denial reports, charge lag, and collection metrics.
• Provide reporting and data support to the Billing Supervisor to assist with monitoring performance and trends.
• Track payer performance and reimbursement issues and communicate findings as needed.
  
  

Compliance and Accuracy

• Ensure billing activities comply with payer contracts, coding guidelines, and applicable federal and state regulations.
• Maintain strict confidentiality of patient and financial information in compliance with HIPAA.
• Support internal and external audits related to billing and revenue cycle activities.
  
  

Collaboration and Process Improvement

• Partner with clinical and front office teams to improve documentation, charge capture, and front-end accuracy.
• Identify process gaps or inefficiencies and communicate improvement opportunities to the Billing Supervisor.
• Support implementation and optimization of billing systems and workflows.
• Perform other duties as assigned based on operational needs.
  
  

Requirements

Qualifications and Experience

• Minimum of three years of medical billing and revenue cycle experience required.
• Demonstrated experience performing full-cycle revenue cycle functions independently.
• Strong experience with accounts receivable management and denial resolution.
• Healthcare, medical practice, or ambulatory care experience required.
• Experience working with commercial, Medicare, and Medicaid payers.
  
  

Education and Certifications

• High school diploma or equivalent required.
• Associate’s degree in Healthcare Administration, Business, or related field preferred.
• CPC, CCS, or similar coding or billing certification preferred but not required.
  
  

Knowledge, Skills, And Abilities

• Strong understanding of revenue cycle workflows and reimbursement processes.
• Ability to analyze AR and billing data and identify trends.
• Proficiency with billing and practice management systems.
• Strong organizational skills with the ability to manage high volumes and competing priorities.
• Effective verbal and written communication skills in English.
• Ability to work independently while following established workflows and supervision.
• Ability to remain calm and effective in a fast-paced environment.
  
  

Physical And Work Environment Requirements

• Prolonged periods of sitting and computer use.
• Fast-paced healthcare environment.
• Rare exposure to Bloodborne Pathogens and Other Potentially Infectious Materials. Training provided upon hire.
  
  

Compliance Statement

Phoenix Heart is an Equal Opportunity Employer. Job duties may be modified as business needs evolve.