Revenue Cycle Specialist

Job Summary The Revenue Cycle Specialist at North Mississippi Health Services facilitates effective Revenue Cycle flow, including bill processing, denials and appeals management, and recurring reporting to monitor status and performance. The role operates under the guidance of the Billing Manager and requires knowledge of third‑party payers, contracts, and strong organizational, analytical, and communication skills. Billing & Follow‑Up Process billing by receiving, interpreting, and submitting claims to third‑party payers, both electronically and in hard copy. Conduct billing follow‑up by contacting payers or accessing payer portals to determine payment expectations and resolve any claim issues. Communicate and process third‑party payer and patient inquiries accurately and in a timely manner. Denial Management Develop strategy for appeals, appeal follow‑up, or re‑processing accounts. Analyze denials and determine reasons for denial. Identify trends and report significant and recurring issues with potential solutions to the Denials Management Supervisor and Billing Manager. Take corrective action through systematic and procedural development to reduce or eliminate payment issues. Contract Management Maintain familiarity with payer methodologies and communicate with NMHS staff. Manage paid claims to resolve under‑paid accounts. Analyze underpayments and identify trends; report issues and solutions to the Denials and Underpayment Manager. Communication & Liaison Communicate professionally with third‑party carriers, vendors, and hospital contacts to promote contractual compliance. Contact insurance companies regarding denial, under‑payment, or rejection issues. Serve as liaison between payers and hospital departments, physician offices, or patients in resolving denials and under‑payment issues. Reporting Assist in preparing monthly denial and variance reports. Regulation Adhere to NMHS/NMMC policies, procedures, guidelines, and applicable local, state, and federal regulations. Qualifications Education Required: Bachelor’s Degree in Business, Coding, or equivalent field. Considered: Associate’s Degree with 4+ years Claims/Billing/Revenue Cycle experience. Considered: High School Diploma or GED with 8+ years Claims/Billing/Revenue Cycle experience. Experience 1–3 years of experience in revenue cycle operations, claims processing, or billing follow‑up. Licenses & Certifications No specific license required. Knowledge, Skills and Abilities Excellent analytical and problem‑solving skills. Good organizational and communication skills. Excellent interpersonal skills. Proficient with Microsoft Office, Outlook, and third‑party payer websites. Research, analyze, and communicate payer trends to identify reimbursement and training issues. Professional and effective communication with third‑party carriers, vendors, and hospital contacts. Develop input for payer report cards in conjunction with contracting and other revenue cycle departments. Member of the Denials Committee. Provide training sessions to Billing and Follow‑up staff as needed. Effective negotiation skills to resolve difficult claims issues. Gather and share information with tact and diplomacy. Extensive contact with patients, payers, physician office staff, coding staff, Credentialing, Case Management, department heads, and all staff within the department. Physical Demands Constant standing. Frequent walking. Frequent lifting/carrying of 50 lbs. Frequent pushing/pulling. Occasional climbing, balancing, stooping, kneeling, and bending. Frequent reaching/over‑head work. Frequent grasping and speaking. Constant hearing. Constant repetitive motions. Frequent eye/hand/foot coordination. Benefits Continuing Education. 403(b) Retirement Plan with Employer Match Contributions. Pet, Identity Theft, and Legal Services Insurance. Wellness Programs and Incentives. Employee Assistance Program. Medical Benefits. License and Certification Reimbursement. Life, Long‑Term and Short‑Term Disability, Group Accident, Critical Illness, and Hospital Indemnity Insurance. Employee Discount Program. Early Access to Earned Wages. Tuition Assistance. Relocation Assistance. Paid Time Away. Special Employee Rates at NMMC Wellness Centers. #J-18808-Ljbffr