Revenue Cycle Specialist

Revenue Cycle Specialist

The Revenue Cycle Specialist is responsible for reviewing and processing claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

Major Responsibilities/Activities

• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance.
• Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff.
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues.
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim.
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion.
• Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs.
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though.
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved.
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness.
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs.
• Consistently support and demonstrate the company mission and values.
• Perform other duties as assigned.

Other Responsibilities/Activities

• Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager.
• Serve as backup to other team members as required.
• Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager.

Required Education, Skills, & Experience

• High School Diploma.
• At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience.
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though.
• Ability to organize, prioritize and multi-task.
• Ability to learn, understand, and work within specific compliance, client, and payer requirements.
• Approach all tasks, duties, and interactions with an attitude of continuous improvement.
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods.
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties.
• Ability to function well within a cross-functional team setting and independently.
• Strong critical thinking and analytical skills and attention to detail.
• Proficient in Microsoft Office programs.
• Proficiency in English is necessary for job-related communication, including understanding policies, writing correspondence, and engaging with colleagues or clients.

Preferred Education, Skills, & Experience

• Strong preference for prior EMS billing and/or denials experience.
• Proficient in EMS|MC billing software.

Working Environment

• The office environment is a controlled indoor setting with minimal exposure to adverse conditions.
• Noise levels in the office are typically moderate and consistent with a standard office setting.
• For employees approved to work in a hybrid or remote setting, a quiet, private workspace free from significant distractions is required to ensure productivity during work hours.
• A reliable internet connection is required for hybrid/remote work. EMS|MC will provide necessary equipment, including a computer, monitor, keyboard, mouse and headset.

Physical Requirements:

• Sitting: frequent and prolonged periods of sitting at a desk while working on a computer.
• Communication: frequent and prolonged periods of speaking, listening, reading, and writing.
• Fine motor skills: frequent use of hands for typing and operating a computer mouse.
• Movement: occasional walking and climbing of stairs; limited bending, kneeling, lifting, and carrying of office-related items.

Pay: $17.00 - $20.00/hour. Individuals in this role are eligible to participate in a discretionary bonus plan and a comprehensive benefit package, including a retirement plan, health coverage, and paid time off.

Employees must be able to perform the essential functions of this position. Reasonable accommodations will be provided to qualified individuals with disabilities as needed to support their ability to perform these essential functions. If you require an accommodation for this position or to participate in the application process, please contact HR at View email address on click.appcast.io.

The responsibilities and duties outlined in this job description are not exhaustive and may be subject to change to meet the needs of the business. This job description is not an implied contract of employment and does not alter the at-will employment relationship.

There is no anticipated closing date for applications; The role will remain open until filled.

Applicants must be authorized to work in the United States now and in the future; this role does not offer current or future visa sponsorship.