Revenue Cycle Specialist
First Source LLC
Role Description
The Revenue Cycle Denials Representative is responsible for managing and resolving denied Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role identifies root causes of denials, executes appeals and corrective actions, and collaborates with internal teams to prevent future denials. The ideal candidate has hands-on experience with CARC/RARC denial codes, Epic denial work queues, and payer-specific appeal requirements across Medicare, Medicaid, and commercial payers.
Roles & Responsibilities
Denial Review & Resolution - PB & HB
- Review and analyze denied PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims to determine root causes and appropriate resolution strategies.
- Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
- Work claims across all top denial categories including, but not limited to: No Authorization, Timely Filing, Coordination of Benefits (COB), Medical Necessity, Additional Documentation Requests (ADR), Bundling (NCCI edits), and Duplicate Claims.
- Interpret CARC and RARC codes on 835 ERA / EOB remittance data for both PB and HB claims to determine the correct resolution path.
- Understand when claim corrections, rebilling (837P or 837I), or void-and-replace actions are appropriate.
- Escalate claims with payers for resolution when processing is inaccurate or delayed.
Appeals & Reconsiderations
- Prepare and submit appeals and reconsideration requests in compliance with payer-specific guidelines and deadlines for both PB and HB denied claims.
- Attach appropriate clinical documentation, medical records, authorization references, and justification letters to support appeal submissions.
- Meet appeal deadlines for Medicare, Medicaid, and commercial payers in accordance with payer-specific requirements.
Trend Identification & Prevention
- Identify denial trends across PB and HB claim types and collaborate with coding, clinical, and billing teams to implement corrective actions.
- Monitor payer policy and regulatory changes (Medicare LCDs/NCDs, Arkansas Medicaid updates) to proactively prevent denials.
- Assist in developing best practices and training materials for PB and HB denial management and prevention.
Payer & System Knowledge
- Navigate Epic denial and underpayment work queues for both HB and PB modules; document all denial actions and resolutions.
- Utilize payer portals (Availity, Arkansas DHS, Medicare.gov, and commercial payer sites) to research denial reasons and submit appeals.
- Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.
Compliance & Documentation
- Maintain thorough documentation of denial reasons, appeal actions, and resolutions in Epic.
- Ensure compliance with federal, state, and payer regulations as well as hospital and physician practice policies.
- Communicate effectively with insurance representatives and internal leaders to expedite resolution and improve processes.
- Always maintain confidentiality of patient and account information (HIPAA).
- Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct.
- Maintain awareness of and actively participate in the Corporate Compliance Program.
- Maintain a confidential and orderly remote work area.
- Meet specified goals and objectives assigned by management and/or the Client.
- Assist with other projects as assigned by management.
Expected / Key Results
- Deliver high levels of client and patient satisfaction (CSAT)
- Achieve quality scores per defined process standards
- Deliver defined process-specific metrics (e.g., denial resolution rate, overturn rate, appeal success rate)
- Adherence to regulatory compliance requirements
- Schedule adherence
Preferred Educational Qualifications
- High school diploma or equivalent required
- Associate's or Bachelor's degree in Health Information Management, Business, or related field preferred
- CPC, CPMA, CRCR, or CHFP certification a plus
Preferred Work Experience
- 2+ years of experience in healthcare revenue cycle, denial management, or claims resolution
- Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) denials
- Prior experience with Epic denial work queues strongly preferred
- Familiarity with Medicaid, Medicare, and commercial payers preferred
- Experience interpreting CARC/RARC codes and 835 ERA / EOB remittance data
- Knowledge of NCCI edits, LCD/NCD policies, and authorization/pre-certification workflows
Competencies & Skills
- Strong knowledge of PB and HB denial workflows, appeal processes, and payer-specific requirements
- Proficiency with Epic (HB and/or PB modules, denial work queues, claim correction, void-and-replace, and rebilling)
- Solid understanding of CARC/RARC denial reason codes and how to act on them for PB and HB claims
- Ability to read and interpret 835 ERA / EOB remittance advice for both PB and HB claims
- Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites
- Competent in working and communicating effectively with payers, patients, colleagues, and management - both in-person and via remote virtual platforms
- Consistently maintains a courteous and professional demeanor
- Self-motivated with the ability to stay focused and productive with minimal supervision
- Proactive initiative and creative problem-solving in carrying out job responsibilities
- Ability to prioritize multiple tasks through effective time management and organizational skills
- Proficiency in PC operations; ability to type at a rate of 30-40 words per minute
Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.
We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.
Not Accepting Referrals
- ...Role Description The Revenue Cycle Denials Representative is responsible for managing and resolving denied Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role identifies root causes of denials, executes appeals and corrective actions...SuggestedWork experience placementLocal areaRemote work
- ...Role Description The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid...SuggestedWork experience placementLocal areaRemote work
- The Louisville VA Health Care System seeks a Supply Technician (Medical) to support Medical Supply Distribution across wards, clinics, operating rooms and storage locations. You will provide sterile and non-sterile supplies, instrument sets and equipment to clinical areas...Suggested
- ...Regional Medicaid Specialist Weekly pay, health and dental after your first month, student loan repayment, a competitive 401(k) match... ...gaps. Collaborates with facility billing and corporate revenue cycle teams to reduce pending Medicaid balances, minimize bad debt...SuggestedWeekly payWork at officeLocal area
- ...Company in The Midwest. Position Overview The Regional Medicaid Specialist manages Medicaid eligibility, applications, and pending... ...coverage gaps. Collaborates with facility billing and corporate revenue cycle teams to reduce pending Medicaid balances, minimize bad debt...SuggestedWeekly payWork at officeLocal area
- ...impact. Position Summary: The Housing Finance & Operations Specialist is responsible for supporting the financial management,... ...Prepare journal entry postings for submission to Controller # Revenue and payment posting # Monthly reconciliations of receivable...Hourly pay
- ...Division of Student Affairs is seeking to hire a Student Services Specialist II. The Student Services Specialist provides technical... ...functional backup to the StarRez Systems Administrator during reporting cycles, system upgrades, or other operational needs. Essential Duties...Full timeContract workPart timeAfternoon shift
- ...Receiving Specialist As a Receiving Specialist, you will be responsible for managing the store's backroom operations by receiving products... ...- career opportunities! Exciting opportunities to represent Cycle Gear at special events -- International Motorcycle Show,...Hourly payPart timeImmediate startShift workNight shiftAfternoon shift
$60k - $90k
...agreements into billed, collected, and reported revenue, serving as the operational bridge... ..., and reporting. The Senior Billing Specialist is a key contributor to the OTC team,... ...Execute month-end and mid-month billing cycles across all product lines, includingSaaS,...Contract workWork at officeRemote work- ...loading of their order, pull and stage materials to be picked up and/or delivered, help maintain the inventory in the Yard by conducting cycle counts, and keep the Yard organized and clean. Equipment used includes a forklift and if youhavent operated one previously, we will...Full timeTemporary workFor contractors
- ...Skilled Nursing Home Billing Specialist ClearView Healthcare Management is looking for a Skilled Nursing Home Billing Specialist... ...bonus structure based on individual performance and overall revenue cycle team goals ~ Comprehensive healthcare benefits ~401(k) retirement...Full timeWork at officeLocal areaFlexible hours
- ...one of our brands, our Sourcing team ensures the timely delivery of quality, profitable goods. The Assistant / Associate Sourcing Specialist works closely with Graphic Design, Tech Design, Merchandising, Apparel Design, Legal, and Merchandise Planning to manage product...Work from homeHome officeOverseasMonday to Friday
$24.65 - $27.1 per hour
...Other duties as assigned by Manager/Supervisor. Possible travel for education sessions, CME events, etc. as defined by Physician Revenue Cycle Leadership. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on...Temporary workWork at officeLocal areaRemote work- ...electronic medical record system to manage and update provider enrollment information. This role will also work closely with our Revenue Cycle and Finance Team to investigate and resolve payer-related claim denials, identify enrollment issues impacting reimbursement, and...Full timeTemporary workWork at office
- ...client information and potential issues Facilitates root cause analysis and recommendations for resolution Reviews weekly Revenue Cycle Reports Assigns Coordinators and delegates tasks as appropriate based on report data Consolidates issues, logs, and notifies...Contract workWork experience placementWork at office
- ...and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle. Waystar’s healthcare payments platform combines innovative, cloud‑based technology, robust data, and unparalleled client support...Full timeLive outLocal areaFlexible hours
$7.25 per hour
Experience Required 3 - 5 years Minimum Education Required High School Diploma/G.E.D. Compensation $7.25 / hourly Hours Per Week 40 Number Of Positions 1 Work Schedule and Shift Requirements First (Day) Job Description Location: Remote ...Hourly payFull timeLocal areaRemote workMonday to FridayShift work- ...support continuous improvement and trend analysis. Verify critical‑to‑quality (CTQ) process parameters such as wash temperatures, drying cycles, ironer settings, and hygiene validation steps. Conduct or coordinate scale verification and equipment calibration checks as part...Work at officeLocal areaFlexible hours
- ...packaging components which support 16,000+ restaurants and $20B in revenue across Pizza Hut, KFC, Taco Bell, and Habit Burger & Grill in... ...(queries to identify data issues), and System Development Life Cycle (SDLC). Prefer Blue Yonder Expertise: Comprehension of data models...Work at officeRemote work
- ...Delivery Specialist At Bestway our Delivery Specialists play a pivotal role in our vision to enhance the customers rent to own experience. We expect our Delivery Specialists to be customer centric individuals that not only deliver products but also deliver an exceptional...Full time
- ...Delivery Specialist The Delivery Specialist will maintain and operate store vehicles to deliver parts and/or products to professional customers in a safe and efficient manner. This position will also collect money on C.O.D. deliveries and pick up customer returns....Local areaImmediate startFlexible hours
$7.25 per hour
...are hiring responsible, trustworthy individuals to join the Datavant team for a specialized, part-time role as a Chart Retrieval Specialist. This role involves visiting various provider offices to retrieve medical records, utilizing excellent customer service skills and...Hourly payFull timePart timeCasual workRemote workHome officeMonday to FridayShift work3 days per week$7.25 per hour
Experience Required None Minimum Education Required High School Diploma/G.E.D. Compensation $7.25 / hourly Hours Per Week 40 Number Of Positions 1 Work Schedule and Shift Requirements First (Day) Job Description Datavant is the data collaboration...Hourly payFull timeWork experience placementWork at officeRemote workMonday to FridayShift work- Waystar in Louisville, KY is seeking a Trading Partner Client Enablement Analyst to deliver accurate provider enrollment and form mapping work within defined workflows. You will combine structured execution with problem solving and ensure timely completion of enrollment...
- ...The Delivery Specialist will maintain and operate store vehicles to deliver parts and/or products to professional customers in a safe and efficient manner. This position will also collect money on C.O.D. deliveries and pick up customer returns. Bilingual candidates encouraged...Local areaImmediate startFlexible hours
$70k - $100.2k
This job is with JLL, an inclusive employer and a member of myGwork – the largest global platform for the LGBTQ+ business community. Please do not contact the recruiter directly. JLL empowers you to shape a brighter way . Our people at JLL are shaping the future...Daily paidContract workTemporary workLocal areaImmediate startRemote work- ...workforce resource and to make a positive impact on people’s lives. Malone is actively recruiting enthusiastic and motivated Staffing Specialists to join our team. If you are passionate about working with clients and employees, a problem‑solver, relationship builder, and...Full timeCasual workWork at officeMonday to Friday
- ...ID: 128766 Facility Group: Norton System Services Job Description Responsibilities The role of the Child Life Specialist is to assess, plan, implement, and evaluate psychosocial patient/family needs for patients aged neonatal to 17 years (Neonates, Pediatric...Full timeInternshipRelocation package
- A leading travel agency is seeking a Remote Travel Specialist to support clients throughout their travel journeys. You will assist with inquiries, booking modifications, and provide essential information, ensuring a seamless experience. Ideal candidates should possess...Remote work
$500 per month
...attention to detail and multitasking? Ready to take charge behind the scenes and keep our store moving at full speed? As the In Stock Specialist, you will serve as the store's point person for in-stock integrity, pricing accuracy, and the optimal performance of The Fresh...Flexible hoursAfternoon shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Revenue Cycle Specialist. Be the first to apply!
- mental health specialist Louisville, KY
- instructional technology specialist Louisville, KY
- resolution specialist Louisville, KY
- criminal justice specialist Louisville, KY
- returns specialist Louisville, KY
- restaurant specialist Louisville, KY
- wellness specialist Louisville, KY
- import specialist Louisville, KY
- drug safety specialist Louisville, KY
- protection specialist Louisville, KY


