Revenue Cycle Specialist
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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