Revenue Cycle Specialist

“Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”Job SummaryThe Revenue Cycle Specialist supports the daily operations of the revenue cycle department, analyzing billing data, investigating denial trends, and processing claim corrections, in order to optimize reimbursement rates, ensure data accuracy, and assist management in financial reporting.Essential Job FunctionsReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Analyze claim denials and rejection trends, reviewing explanations of benefits and coordinating with coding teams to submit timely appeals, in order to recover revenue and minimize uncollectible debt.Generate and maintain routine financial and operational reports, extracting data from the Electronic Health Record and tracking Key Performance Indicators (KPIs), in order to provide visibility on revenue performance to the leadership team.Assist in the maintenance of payers, charge master and fee schedules, updating system configurations and vendors based on CMS guidelines and payer contract changes under the Manager's supervision, in order to ensure billing compliance and claim accuracy.Audit patient accounts and billing records, verifying demographic and insurance information against payer requirements and internal policies, in order to prevent front-end rejections and ensure clean claim submission.Collaborate with the RCM vendors and internal departments, providing specific case examples and documentation for issue resolution, in order to facilitate smooth billing operations and efficient problem-solving.Daily interaction with Operations team.Payment posting, tracking, and reconciliation.Responsible for RCM workflow review and updates for center operations.Prepare and generate ADHOC reports in a daily, monthly, and quarterly basis.Identify Revenue cycle bottlenecks and recommend strategies for optimization.Supervisory ResponsibilitiesThis position has no supervisory responsibilitiesRequired EducationBachelor’s degree.Required Experience3 years of work-related experience.Required Licenses and CertificationsN/ARequired Knowledge, Skills, and AbilitiesKnowledge of third-party payer requirements including federal, state, and private health care plans and authorization process.Proven experience in healthcare billing.Knowledge of basic insurance policies, procedures, and reimbursement.Attention to Detail: High level of accuracy in data entry and reviewing medical claims to prevent errors.Analytical Thinking: Ability to identify billing trends and solve basic payment issues.Organization: Strong organizational skills to prioritize tasks, track deadlines, and manage open claims effectively.Technical Skills: Proficiency in Microsoft Excel (formulas, spreadsheets) and experience with practice management softwareCommunication: Clear verbal and written communication skills to interact with insurance companies and internal teams.Preferred QualificationsBachelor's degree in Health Information Management, Business, Finance, Accounting, or a related field; or equivalent combination of education and experience3+ years of progressive revenue cycle experience in a healthcare provider setting, including direct experience with claim denials, payer appeals, and payment reconciliationWorking knowledge of ICD-10, CPT coding conventions, and payer billing requirementsExperience with Medicare, Medicaid, and commercial payer billing rulesProficient knowledge in ExcelFinancial ResponsibilitiesThis position does not hold direct finance responsibilities or authority in the preparation of financial statements but contributes to revenue performance monitoring and supports financial reporting for the revenue cycle function.Budget ResponsibilitiesThis position does not hold direct budget authority but contributes to revenue performance monitoring and supports financial reporting for the revenue cycle function.LanguagesAdvanced English is required.Bilingual Spanish is preferred.TravelN/APhysical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.While performing the duties of this job the employee is regularly required to work standing up, walk, use hands to operate tools and equipment and must be able to exert regularly up to 10 pounds of force, frequently exert 30 pounds of force and occasionally exert 50 pounds of force to constantly perform the essential job functions. The employee will be frequently required to reach with hands and arms, bend, balance, kneel, crouch, crawl, push, and pull. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.Environmental ConditionsInside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.Physical/Environmental ActivitiesPlease confirm for the following questions if these working conditions are encountered Occasionally (1-33% of time on the job), Frequently (34-66% of time on the job), Constantly (67-100% of time on the job), or Not Applicable N/AMust be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Not Applicable N/AMay be exposed to outdoor weather conditions of cold, heat, wet, and humidity. Not Applicable N/AMay be exposed to outdoor or warehouse conditions of loud noises, vibration, fumes, dust, odors, and mists. Not Applicable N/AMust be able to ascend and descend ladders, stairs, or other equipment. Not Applicable N/ASubject to exposure to hazardous material. Not Applicable N/AWe are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of the company. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder’s responsibility. #J-18808-Ljbffr