Revenue Cycle Specialist

A Revenue Cycle Specialist is responsible for the timely and accurate resolution of medical claims. This involves actively monitoring unpaid and denied claims, collaborating with the coding team, and meticulously working through payer correspondence. They ensure the accuracy of Explanations of Benefits (EOBs), investigate denial reasons, and submit necessary documentation for claim resolution. Additionally, they review patient bills for correctness, handle secondary insurance submissions, and proactively identify and prevent potential billing issues. The specialist also serves as a point of contact for billing inquiries from patients and insurance companies, assisting the Revenue Cycle Management director with various daily tasks as needed.

Responsibilities

• Monitors unpaid claims to determine necessary actions to assure timely resolution
• Works payer correspondence and resolves requests
• Monitors denied claims, in collaboration with coding team, to facilitate timely resolution
• Monitors EOBs for accuracy
• Obtains and submits necessary documentation required for submitted claims resolution
• Reviews patient bills for accuracy and completeness of insurance payment and contractual adjustments
• Performs tasks associated with secondary insurance claim submission, including copying, preparing, and attaching EOB from primary payer as necessary
• Anticipates potential billing/reimbursement problems and takes measures to prevent them
• Answers billing related questions from patients and insurance companies
• Assists the RCM director in a variety of other daily tasks, as necessary

Education and Qualifications:

• High school graduate or GED equivalent
• Insurance billing and/or coding experience required
• Certified professional biller preferred or ability to obtain through the AAPC within 2 years
• Maintains knowledge of current regulations and policies for the federal, state and private payers
• Maintains knowledge of CPT and HCPCS codes
• 5 years of experience required

Job Skills:

• Demonstrates the ability to achieve accuracy and consistency
• Applies knowledge to produce “clean claims”
• Monitors unbilled accounts and/or uncoded encounters to reduce any billing delays
• Applies knowledge of regulatory mandates and reporting requirements

Compensation

Starting Hourly Pay: $17 per hour

Salary based on experience- Starting pay will be determined based on the candidate's relevant skills, qualifications, and experience.

Work Location: On-Site (In-Person)