Revenue Cycle Specialist

The Revenue Cycle Specialist is responsible for providing accurate and timely processing of claims and patient accounts to ensure maximum reimbursement for the organization. This position works closely with all teams within revenue cycle as well as admissions, utilization review, and compliance to maintain strong revenue cycle processes.

Key Performance Responsibilities:

• Accurate and timely submission of patient demographic and insurance information.
• Verify patients' eligibility and benefits, reverify when necessary.
• Submit clean claims to payers electronically and via mail.
• Manage relationships with various insurance payers.
• Follow up with insurance companies on denied and rejected claims to ensure timely resolution.
• Monitor patient accounts receivable and follow up on outstanding balances with the goal to reduce delinquency.
• Identify and pursue opportunities for improvements in billing process and denial resolution.
• Respond to patient inquiries regarding billing and insurance.
• Maintain accurate and up-to-date records of all claims and patient accounts
• Perform other duties as assigned.

Education, Experience, License Requirements:

• High School Diploma/GED required. Bachelor's degree in business or related field preferred (statistics, computer science, analytics).
• Minimum three (3) years' experience in revenue cycle related roles with emphasis on benefit verification, billing and AR follow-up.
• Experience in CPT and ICD-10 coding; familiarity with medical terminology