Revenue Cycle Specialist

Job Summary Revenue Cycle Specialist at North Mississippi Health Services is responsible for facilitating effective revenue cycle flow, including bill processing and resolution, denials and appeals management, and recurring reporting to monitor status and performance. This role operates under the guidance of the Billing Manager and requires an experienced individual with knowledge of third‑party payers and contracts and excellent organizational, analytical, and communication skills to interface with payers, vendors, and staff in claims review, analyze reports and claims to identify underpayments and trends, and facilitate action to support claim resolution and payment capture, promoting overall effective and efficient area function and the financial health of the organization. Job Functions Billing & Follow Up: Processes billing by receiving, interpreting, processing, and submitting through various edits to third‑party payors electronically and in hard copy format. Conducts billing follow‑up by contacting third‑party payers or accessing payer websites/provider portals to determine payment expectations and resolve any problems on the claim. Facilitates information communications and processing by interpreting and processing third‑party payor and patient inquiries accurately and timely to expedite payment. Denial Management: Manages denial receivable to resolve accounts. Develops strategy for appeal, appeal follow‑up and/or reprocessing accounts. Analyzes denials to determine reason they occurred. Identifies trends and reports significant and recurring issues along with possible solutions to the Denial Management Supervisor and Billing Manager. Takes corrective action through systematic and procedural development to reduce or eliminate payment issues. Contract Management: Maintains familiarity with payer methodologies and the ability to communicate with NMHS staff. Manages paid claims to resolve underpaid accounts. Develops strategy for appeal, appeal follow‑up and/or reprocessing accounts. Analyzes underpayments to determine reason they occurred. Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment Manager. Communication: Professionally and effectively communicates with third‑party carriers, vendors, and hospital contacts to promote contractual compliance. Liaison: Contacts insurance companies regarding denial, underpayments or rejection issues. Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues. Reporting: Assists in preparation of monthly denial reports and other denial reports as requested. Assists in preparation of monthly variance reports and other variance reports as requested. Regulation: Adheres to NMHS/NMMC Policies/Procedures/Guidelines. Complies with applicable Local/State/Federal policies/procedures/guidelines/laws/statutes. Qualifications Education: Bachelor's Degree in Business, coding or equivalent field. Required Associate's Degree – Willing to consider 4 yrs Claims, Billing/Follow‑Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required High School Diploma or GED Equivalent – Willing to consider 8 yrs Claims, Billing/Follow‑Up, or revenue cycle experience beyond minimum requirement in lieu of Bachelor degree. Required Work Experience: 1–3 years Skills: Excellent analytical and problem‑solving skills Good organizational and communication (written and verbal) skills Excellent interpersonal skills Computer skills with strong Microsoft Office, Outlook, Third‑Party Payer websites Must be able to research, analyze and communicate payer trends to identify reimbursement and training issues Must professionally and effectively communicate with third‑party carriers, vendors, and hospital contacts to promote contractual compliance Must provide input and help design payer report cards in conjunction with contracting, managed care, and other revenue cycle departments Must serve as member of the Denials Committee Must conduct training sessions with Billing and Follow‑up staff as needed Must have effective negotiating skills, including the ability to resolve difficult claims issues Must be able to gather and share information with knowledge, tact, and diplomacy Must have extensive contact with patients, payers, physician office staff, coding staff, Credentialing, Case Management, various Department heads, and all staff within the department Physical Demands Standing – Constantly Walking – Frequently Sitting – Rarely Lifting/Carrying – Frequently 50 lbs Pushing/Pulling – Frequently Climbing – Occasionally Balancing – Occasionally Stooping/Kneeling/Bending – Frequently Reaching/Over Head Work – Frequently Grasping – Frequently Speaking – Occasionally Hearing – Constantly Repetitive Motions – Constantly Eye/Hand/Foot Coordinations – Frequently Benefits Continuing Education 403B Retirement Plan with Employer Match Contributions Pet, Identity Theft and Legal Services Insurance Wellness Programs and Incentives Referral Bonuses Employee Assistance Program Medical Benefits Dental Benefits Vision Benefits License + Certification Reimbursement Life, Long‑Term and Short‑Term Disability, Group Accident, Critical Illness and Hospital Indemnity Insurance Employee Discount Program Other: Early Access to Earned Wages Tuition Assistance Relocation Assistance Paid Time Away Special Employee Rates at NMMC Wellness Centers #J-18808-Ljbffr