Revenue Cycle Representative I - II

Job Description

Job Description

The Revenue Cycle Representative I & II (RCR I & RCR II) is a member of the internal back-end revenue cycle team responsible for the patient-facing and account-level financial functions that remain in-house and are not managed by UPNT’s outsourced Revenue Cycle Services (RCS) vendor (Veradigm). This role serves as the primary point of accountability for work queue oversight & resolution, revenue cycle pools/chats, legacy AR management, unapplied payment research, patient escalation calls, patient accounts receivable (A/R) follow-up, outsource collection agency payment posting and reconciliation, patient payment plan administration, refund management, and referral and prior authorization coordination. The RCR I ensures timely, accurate, and compliant handling of patient accounts to support the organization's cash flow, patient satisfaction, and regulatory compliance goals.

Essential Job Responsibilities:

RCR I:

•      Monitor active payment plans for missed or late payments and initiate appropriate follow-up.

•      Modify, extend, or default payment plans per policy and appropriate approval levels.

•      Communicate plan terms, changes, and reminders to patients in a clear, compliant manner.

•      Review, prioritize, and work assigned work queue items daily within established productivity and turnaround-time standards.

•      Research root causes of account holds, edits, denials routed to internal queues, and credit balances and respond back to the Veradigm AR team member on next action steps.

•      Document all work queue actions clearly and consistently in the practice management/EHR system.

•      Escalate systemic or recurring work queue issues to the supervisor for trend analysis and process improvement.

•      Maintain work queue aging within departmental benchmarks by proactively managing and updating items to prevent them from exceeding the 45-day aging threshold.

•      Reconcile unapplied and unidentified patient payment reports on a regular cadence (e.g., weekly).

•      Research payment source, remittance detail, and patient account history to determine correct application.

•      Research and confirm Missing Charges are all accounted for the unapplied payment in question.

•      Confirm upcoming visits to which the patient payment can move to

•      Process account transfers or reapplication of misapplied payments in accordance with practice policy.

•      Present account refunds when all criteria above have been satisfied.

•      Coordinate with cash posting/lockbox functions to resolve payment identification discrepancies.

•      Maintain documentation supporting all payment application decisions for audit purposes.

Additional Responsibilities for RCR II include:

•      Receive and respond to escalated patient calls regarding billing disputes, statement concerns, or complaints transferred from front-line staff or the call center.

•      Investigate account history, insurance adjudication, and prior communications to provide an accurate, complete resolution.

•    Apply de-escalation and service-recovery techniques to resolve patient concerns professionally and empathetically.

•      Document escalation details, resolution, and any follow-up commitments in the patient account record.

•      Orphan Payment Phreesia Reconciliation.

•      Identify and report patterns in escalations that may indicate upstream process or communication issues.

•      Monitor and work Patient A/R aging reports greater than 90 days to reduce outstanding balances within target timeframes.

•      Initiate outbound contact (calls, Phreesia notifications/statements, portal messages) to patients regarding balances due.

•      Prepare accounts for next-level action (e.g., payment plan, pre-collection notice, or agency placement) per policy.

•      Process adjustments, corrections, and account reconciliations within approved authority levels.

•      Process refund requests for both insurances and patients utilizing the Credit Balance Management tool monthly after thorough account review.

•      Evaluate accounts for financial assistance, hardship, or write-off eligibility per policy and refer accordingly.

•      Other duties, as assigned

Work Experience:

• RCR I: 0–2 years of experience in medical billing, collections, patient access, or a related healthcare revenue cycle role.
• RCR II: Minimum 2 years of progressive revenue cycle experience, including patient A/R, collections, or payment plan administration.  

Skills:

RCR I & II: 

•      Working knowledge of healthcare billing, insurance terminology, EOB/remittance interpretation, and patient financial responsibility concepts.

•      Proficiency with practice management/EHR systems, work queue tools, and Microsoft Office (Excel in particular).

•      Strong verbal and written communication skills; ability to de-escalate difficult patient conversations with empathy and professionalism.

•      Sound judgment in applying financial assistance, adjustment, and collection policies.

•      Detail-oriented with strong organizational and time-management skills to manage competing priorities and deadlines.

•      Understanding of HIPAA, CMS, and other applicable regulatory requirements governing patient billing and collections.

•      Ability to work collaboratively with internal departments and external partners, including collection agencies and payers.

Physical Requirements:

RCR I & II

•      Primarily performed in an office or remote/hybrid setting with extended periods of computer and phone use.

•      Requires sitting for extended periods; occasional standing, walking, and light lifting (up to 15 lbs).

•      Requires use of telephone/headset for extended call volumes, particularly for escalation handling.

•      May require occasional flexibility in schedule to support month-end close or high-volume periods.

Education:

RCR I & RCR II:

•      High school diploma or equivalent required.

•      Associate degree or coursework in healthcare administration, business, or related field preferred.

Certifications:  (Preferred, Not Required)

•      Certified Revenue Cycle Representative (CRCR) or equivalent industry certification.

•      Certified Patient Account Representative (CPAR), Certified Professional Biller (CPB), or similar.