Billing & Revenue Cycle Specialist - Occupational Health

The Billing & Revenue Cycle Specialist provides revenue cycle and administrative support for Occupational and Employee Health services, including billing, accounts receivable follow-up, denial resolution, cash handling, employer account maintenance, documentation management, and coordination of daily operational support activities. This role collaborates with clinical staff, employers, payers, and internal departments to support timely reimbursement, regulatory compliance, and efficient clinic operations.

Education, Licensure, Certification and Experience requirements:

• High School diploma or equivalent required.
• Associate’s degree preferred.
• Certified Revenue Cycle Specialist (CRCS) required.
• Minimum two (2) years’ experience in medical billing, credit and collections required.

Competencies, Knowledge, Skills and Abilities:

• Knowledge of revenue cycle processes, including billing, accounts receivable, and denial resolution.
• Familiarity with electronic claims submission, remittance processing (ERA), and electronic funds transfer (EFT).
• Strong analytical and problem-solving skills with the ability to resolve claim discrepancies.
• High level of accuracy and attention to detail in data entry and financial reconciliation.
• Ability to prioritize and manage multiple tasks in a fast-paced clinical environment.
• Proficiency in Microsoft Office applications, including Word and Excel.
• Ability to learn and effectively utilize SYSTOC EMR and related software systems.
• Strong organizational skills with the ability to maintain confidential records.
• Effective interpersonal and customer service skills.
• Strong written and verbal communication skills.
• Strong initiative with ability to independently prioritize and manage workload
• Adaptability and initiative in managing workload and responding to change.

Essential Job Duties:

Revenue Cycle/Accounts Management:

• Process daily, monthly, and ad hoc billing for Occupational Health and Employee Health services, including insurance, workers’ compensation, and direct-to-employer accounts.
• Perform charge entry, payment posting, daily deposits, and accounts payable/accounts receivable functions within SYSTOC and in coordination with the Augusta Health centralized billing department.
• Oversee assigned accounts receivable to ensure claims are processed to completion and reimbursement is optimized.
• Identify and resolve invalid, incomplete, or missing claim data prior to and following claim submission.
• Research and resolve denied claims, including preparation and submission of appeals; correct claim data and rebill as appropriate.
• Maintain working knowledge of payer standard transaction sets, including electronic claim submission, electronic remittance advice (ERA), code sets, and electronic funds transfer (EFT) processes to ensure timely payment and account resolution.
• Support the acquisition and verification of required referrals, authorizations, workers’ compensation data, and claim numbers necessary for treatment coordination and claim submission.
• Respond promptly to payer, employer, and patient correspondence regarding billing and claims.

Cash Handling & Financial Reconciliation:

• Coordinate daily cash flow processes, including balancing cash drawers and reconciling daily deposits.
• Monitor deferred revenue records and related tracking spreadsheets.
• Maintain accurate and organized departmental billing files.
• Prepare and distribute daily and monthly billing and revenue reports to department leadership.

Systems, Data Management & Documentation:

• Accurately enter and maintain employer account information and data, new company set-ups, and company-specific requirements within SYSTOC and the OH/EH database.
• Record and coordinate medical records requests within SYSTOC in accordance with department procedures.
• Maintain proficiency in SYSTOC EMR and other systems utilized in the day-to-day functions of Occupational and Employee Health.

Coordination & Department Support:

• Serve as liaison between employers, insurance carriers, workers’ compensation representatives, nursing staff, providers, and department leadership to facilitate communication and timely resolution of billing matters.
• Assist in coordinating off-site client testing and scheduling in collaboration with occupational health nurses.
• Assist with development, review, and revision of company agreements as requested.
• Collaborate with Augusta Health’s Workers’ Compensation and Risk Management teams to support safety reporting, data entry, and related initiatives.
• Maintain departmental office forms, supplies, and administrative materials necessary to support daily clinic operations.
• Maintain and organize employer and company records, ensuring documentation is current, complete, and accessible.
• Perform record retrieval, copying, and related documentation support in accordance with department procedures and regulatory guidelines.
• Provide on-site clinic assistance as needed to support patient flow and operational efficiency.
• Provide front desk coverage and administrative support as needed to maintain departmental operations.

Compliance, Analysis & Process Improvement:

• Provide regular feedback to leadership regarding payer issues, recurring denials, provider office issues, and other barriers to timely payment.
• Identify patterns and trends in claim denials or payment delays and escalate systemic issues to leadership.
• Remain informed of federal and state billing regulations and guidelines; report compliance concerns to leadership.

Some benefits of working at Augusta Health include: 

• Generous paid time off to promote work life balance.
• Competitive Pay.
• Retirement Plan.
• Medical, Dental, and Vision Benefits.
• Free onsite parking.
• Tuition reimbursement.
• Onsite childcare.

  Company Information:

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient services which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

  Equal Opportunity:

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

Exceptional care, small town hospitality Nestled in Virginia’s beautiful Shenandoah Valley, Augusta Health is among the finest nonprofit community hospitals in America. Augusta Health opened in 1994 to continue a tradition of personalized care with small-town hospitality that began with predecessor hospitals in Staunton and Waynesboro. Today, our highly trained physicians and staff use state-of-the-art technology to provide top quality care with warmth and compassion. We offer many amenities so patients and families can be comfortable and close during difficult times. View Our Mission, Vision & Values. If you are a resident of Augusta County, Staunton, Waynesboro, or surrounding areas, you can benefit from a variety of programs we host to promote good health. If you are a dedicated healthcare professional, you will find exciting career opportunities at Augusta Health. Quick Stats for 2023 Licensed for 255 beds 124 Medical/Surgical 14 Intensive Care Unit 18 Labor and Delivery 4 Pediatric Non-traditional, Non-acute services 28 bed psychiatric unit 17 bed skilled nursing unit 8 bed rehab unit Largest local private employer Employees: 2,375+ Active Physicians: 225 APPs: 87 Volunteers: 290 Service Area: 200,000 AH Urgent Cares: 5 AH Practices: 49