Revenue Cycle Coverage and Claims Associate

Revenue Cycle Coverage And Claims Associate II

This role supports the accurate and timely management of insurance coverage, claims, and reimbursement activities within a healthcare revenue cycle environment. You will independently verify eligibility, investigate coverage issues, and resolve account and claim discrepancies across commercial, government, and managed care plans. The position plays an important role in keeping claims on track, addressing denials and underpayments, and ensuring appropriate reimbursement. You will work across Epic, payer portals, clearinghouses, CRM tools, OnBase, and other systems to research and document claim activity. The role also handles escalated issues and bulk claim projects while supporting workflow validation and process improvements. Success requires strong medical billing expertise, attention to detail, sound judgment, and the ability to work independently in a high-volume environment.

The role is responsible for managing coverage and claims activities throughout the revenue cycle, resolving complex issues, maintaining accurate documentation, and supporting reimbursement operations. Key responsibilities include:

• Independently verify initial and ongoing patient insurance eligibility and update demographics, financial, and guarantor information in Epic.
• Work with commercial, government, managed care, and third-party payors to obtain and document required authorizations in accordance with applicable policies and regulations.
• Research missing or incorrect account information using payer portals and other resources, including identifying unknown payors when necessary.
• Review and edit claims and appeals before submission to clearinghouses.
• Analyze, investigate, and resolve claim issues using federal, state, and payer-specific rules and procedures.
• Monitor work queues for claims requiring additional research and document actions taken toward resolution.
• Resolve escalated claims that cannot be addressed at the Associate I level and support bulk claim projects.
• Correct claims rejected by claim scrubbers, clearinghouses, or payors.
• Review explanations of payment, determine appropriate resolution steps for denials, and complete actions such as appeals, write-offs, or statements.
• Investigate payer underpayments and follow up by phone on unpaid aging claims.
• Provide supporting documentation requested by insurance payors.
• Process accurate and timely write-offs for uncollectible accounts in accordance with established policies and guidelines.
• Support CRM activities and use OnBase to manage department-specific documentation.
• Validate new workflows associated with product growth and maintain ownership of designated work queues until functionality is confirmed.
• Provide information and support to ancillary departments and other reimbursement operations teams.
• Assist with special projects, system outages, and periods of increased claim volume.
• Maintain productivity, accuracy, quality, confidentiality, and compliance with HIPAA and applicable medical billing regulations.
• Work effectively with colleagues and stakeholders across different levels through clear written and verbal communication.

The ideal candidate combines practical revenue cycle experience with strong knowledge of medical billing, insurance claims, and reimbursement processes. You should be comfortable navigating electronic health records and payer systems, researching complex claim issues, and working independently while maintaining high standards of accuracy and confidentiality. Key qualifications include:

• High school diploma or GED required.
• At least 1 year of experience in a revenue cycle role.
• At least 3 years of experience in medical billing, claims, and/or insurance processing.
• Current, extensive knowledge of government, managed care, and commercial insurance claim submission requirements, reimbursement guidelines, and denial reason codes.
• Knowledge of medical terminology and health insurance terminology.
• Experience working with EHR systems and electronic medical records.
• Strong computer, keyboarding, and data-entry skills.
• Demonstrated attention to detail and commitment to accurate, high-quality work.
• Strong problem-solving, organizational, and analytical abilities.
• Ability to work independently, remain focused, and manage changing workloads effectively.
• Strong written and verbal communication skills and the ability to collaborate effectively in a team environment.
• Self-motivated, dependable, disciplined, adaptable, and professional.
• Ability to work Monday through Friday during standard business hours and remain at a computer for approximately 90% of the workday.
• Ability to use a computer and telephone simultaneously, including a headset.
• Ability to successfully complete required assessments and achieve a score of at least 80% on applicable Epic process assessments.
• Authorization to work in the United States without sponsorship.
• An associate degree in a related field or medical billing certification is preferred.
• Five or more years of experience in medical or insurance billing is preferred.
• Experience with Epic or another EHR application is preferred.

Base pay of $17.00$34.00 per hour, with ranges potentially varying by location. Fully remote position within the United States. Full-time, Monday through Friday schedule aligned with the Central Standard Time zone, generally 8:00 AM5:00 PM CST. No required travel. Opportunity to contribute to healthcare revenue cycle operations supporting cancer diagnostics. Exposure to complex payer environments, claims resolution, reimbursement processes, and healthcare technology systems. Professional environment emphasizing quality, teamwork, integrity, accountability, and continuous improvement.