Overview
This role involves managing the full revenue cycle billing process, including pre-submission claim scrubbing, rejection resolution, and accounts receivable reconciliation. The position requires expertise across multiple revenue cycle management (RCM) functions and the ability to prioritize competing work queues effectively.
Responsibilities
Accounts Receivable (AR) & Reconciliation (~40%)
- Reconcile ERA/EOB payments against expected reimbursements, identifying and resolving underpayments, overpayments, and missing remittances
- Investigate and resolve payment posting flags within the billing system
- Maintain AR aging reports across assigned payer relationships, prioritizing work by age and urgency
- Communicate directly with payer representatives to resolve outstanding balance disputes
- Coordinate with the RCM platform team on shared AR work queues, tracking responsibilities between platform and internal teams
Claim Submission & Pre-submission Quality Assurance (~35%)
- Perform pre-submission claim scrubbing to catch errors in demographics, eligibility, authorization, coding completeness, and payer-specific requirements
- Verify patient eligibility and benefits across assigned payers prior to claim submission
- Validate prior authorization requirements and ensure authorization numbers are correctly captured on claims
- Identify recurring pre-submission error patterns and provide recommendations for workflow improvements to the RCM Manager
Rejection Resolution (~25%)
- Resolve claim rejections from the RCM platform and payer portals, including 277 rejection reports and real-time rejection queues
- Differentiate between clearinghouse-level and payer-level fixes, coordinating with the platform team as needed
- Maintain a rejection tracking log categorized by error type, payer, and root cause
- Collaborate with Denial Specialists to prevent upstream rejections from becoming downstream denials
Requirements
- Minimum 3 years of medical billing experience covering at least two of the following core functions: AR reconciliation, claim submission/quality assurance, or rejection management
- Ability to manage multiple work queues simultaneously and reprioritize based on aging and volume
- Experience with high-volume ERA/EOB reconciliation at the payer batch level
- Familiarity with 837 claim files, 277 rejection reports, and ERA/835 remittance files
- Knowledge of Medicaid managed care and Medicare Advantage payer requirements
- Experience with clearinghouse and RCM platforms; familiarity with leading billing platforms is a plus but not required
Preferred Qualifications
- Experience resolving capitation or encounter-based payment disputes with payers
- Prior work experience in a lean or startup RCM environment
- Exposure to value-based care or risk-adjusted billing models
- Experience with CMS-1500 and UB-04 forms for both institutional and professional billing
Location
Not specified
Compensation & Benefits
Not specified