Overview
The Revenue Cycle Specialist is responsible for reviewing and processing claims at various stages of the revenue cycle to ensure timely, compliant handling and maximize reimbursement. This role supports operational service commitments for assigned clients.
Responsibilities
- Monitor client performance to identify potential revenue loss or delays and suggest solutions to maximize reimbursement.
- Provide routine feedback on client performance, workflows, industry changes, payer regulations, and concerns to operational and management staff.
- Communicate proactively with payers to identify deficiencies and provide feedback to operational teams to resolve and prevent issues.
- Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and other follow-up activities according to compliance standards and client/payer specifications.
- Independently identify problems, determine causes, and initiate timely resolution steps, following through to completion.
- Collaborate regularly with supervisors and team members to ensure effective prioritization and adherence to standard operating procedures and service level agreements.
- Utilize big picture analysis, critical thinking, innovation, and tenacity to holistically approach client performance.
- Monitor and measure client outcomes against commitments, identifying barriers and suggesting solutions when goals are not met.
- Stay informed of industry changes and regulations to maintain compliance and preparedness.
- Exhibit strong customer service skills to build and maintain internal and external relationships.
- Support and demonstrate organizational mission and values.
- Perform additional duties as assigned.
Additional Responsibilities
- Prepare and present client performance analysis as directed by senior staff or management.
- Serve as backup to other team members as needed.
- Complete other tasks assigned by senior specialists, supervisors, or managers.
Requirements
Education & Experience
- High School Diploma.
- 1-2 years of experience processing health insurance claims, denials, healthcare accounts receivable, medical billing, or at least 1 year of EMS billing experience.
Skills & Abilities
- Ability to analyze client performance holistically using critical and lean thinking, innovation, curiosity, and tenacity.
- Strong organizational, prioritization, and multitasking skills.
- Ability to learn and work within compliance, client, and payer requirements.
- Commitment to continuous improvement.
- Understanding of HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods.
- Adaptability to changes in work environment, procedures, priorities, and duties.
- Ability to work independently and collaboratively within cross-functional teams.
- Strong critical thinking, analytical skills, and attention to detail.
- Proficiency in Microsoft Office.
- Proficient English communication skills for understanding policies, writing correspondence, and engaging with colleagues and clients.
Preferred Qualifications
- Prior EMS billing and/or denials experience.
- Proficiency with EMS|MC billing software.
Working Environment
- Controlled indoor office setting with moderate noise levels.
- For hybrid or remote work, a quiet, private workspace free from distractions is required.
- Reliable internet connection required for hybrid/remote work.
- Necessary equipment such as computer, monitor, keyboard, mouse, and headset will be provided.
Physical Requirements
- Frequent and prolonged sitting at a desk while working on a computer.
- Frequent speaking, listening, reading, and writing.
- Frequent use of hands for typing and computer mouse operation.
- Occasional walking, stair climbing, and limited bending, kneeling, lifting, and carrying of office items.
Compensation & Benefits
- Starting pay: $18.00 per hour, with final compensation based on qualifications, experience, and business needs.
- Eligibility for discretionary bonus plan.
- Comprehensive benefits package including retirement plan, health coverage, and paid time off.
Location
- Position may be office-based, hybrid, or remote depending on approval and role requirements.