Revenue Cycle Specialist I

Overview

This role is responsible for the timely follow-up of billed claims and resolution of accounts receivable. The position oversees account receivables and maintains detailed and accurate account documentation. It involves thorough, accurate, and prompt follow-up on open claims with all supporting documentation. The role also includes maintaining and updating billing guidelines, fee schedules, and contract rates.

Responsibilities

• Review, document, and resolve all incoming correspondence and payor calls.
• Assist with aging reports and report payor issues or denial trends to Lead/Supervisor.
• Appeal and/or rebill underpaid claims and assist with payments as needed.
• Maintain a basic understanding of health insurance plans, policies, and procedures.
• Research and follow up on outstanding claims, documenting all correspondence and actions in the system.
• Contact insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, or other methods.
• Identify issues or trends and provide suggestions for resolution to management, including payer, system, or escalated account issues.
• Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
• Submit requested medical information to insurance carriers.
• Analyze and correct invoices or accounts and maintain work queues.
• Meet or exceed productivity and quality goals.

Skills

• Billing and documentation
• Effective communication
• Customer follow-ups
• Time management
• Medicare and medical billing knowledge
• Proficiency in Microsoft Office and general computer literacy
• Understanding of HIPAA regulations

Qualifications

• High School Diploma or equivalent (GED)
• Minimum of 1 year experience in hospital or physician insurance-related activities such as authorization, billing, follow-up, call center, or collections
• Knowledge of Medicaid and Medicare billing regulations

Preferred Qualifications

• Knowledge of revenue and ICD coding language
• 2 years of experience in hospital or physician insurance-related activities

Physical Requirements

• Manual dexterity to manipulate complex and delicate equipment with precision, including frequent computer, phone, and cable setup and use.
• Ability to lift and utilize full range of movement to transport, pull, and push equipment.
• Capability to work on hands and knees and bend to set up, troubleshoot, lift, and carry supplies and equipment, including heavy items.
• For roles requiring driving: ability to drive a vehicle, including sitting, seeing, and reading signs, traffic signals, and other vehicles.

Compensation & Benefits

• Scheduled weekly hours: 40
• Hourly pay range: $19.29 - $27.45 (dependent on experience)
• Comprehensive benefits package supporting physical, mental, and emotional well-being

Location

• Peaks Regional Office
• Broomfield, Colorado