Revenue Cycle Specialist

Revenue Cycle Specialist

We are looking for an experienced Revenue Cycle Specialist to join our Business Office team. This role plays an important part in keeping the revenue cycle running smoothly, from accurate claim submission and insurance follow-up to denial resolution, payment posting, patient billing, and account reconciliation.

The ideal candidate is detail-oriented, comfortable working in Epic, understands healthcare billing and payer requirements, and knows how to take ownership of an account from initial billing through resolution.

Revenue Cycle & Claims

• Manage assigned Epic work queues and resolve billing issues, claim rejections, and outstanding accounts.
• Review, validate, and submit professional and facility claims to commercial and government payers, managed care plans, third-party administrators, and workers' compensation.
• Correct registration and claim edits, clearinghouse rejections, and payer-specific errors.
• Process rebills, corrected claims, voids, replacements, and resubmissions as needed.
• Submit required medical records, operative reports, invoices, proof of medical necessity, and other supporting documentation.

Accounts Receivable, Denials & Appeals

• Follow up with payers by phone, portals, written correspondence, fax, and other approved communication methods.
• Research unpaid and denied claims, underpayments, coordination-of-benefits issues, authorization issues, coding-related denials, and other reimbursement barriers.
• Prepare and submit appeals, reconsiderations, corrected claims, and supporting documentation.
• Work assigned denials and no-response accounts, including aged, high-dollar, and time-sensitive accounts.
• Identify denial trends, payer issues, underpayments, and other opportunities to improve revenue cycle performance.

Payment Posting & Reconciliation

• Post and reconcile ERAs, EOBs, payments, adjustments, contractual allowances, refunds, and other account transactions.
• Research and resolve credit balances, overpayments, duplicate payments, unapplied cash, and refund requests.
• Assist with payment reconciliation, month-end close, reporting, and audit readiness.

Patient Billing & Customer Service

• Respond to patient billing questions by phone and through MyChart.
• Process patient statement runs.
• Establish, monitor, and update payment plans in accordance with organizational policies.
• Research and resolve patient account questions involving claims, payments, adjustments, insurance coverage, and account documentation.
• Maintain accurate documentation of patient, payer, and internal communications in Epic.

Compliance & Process Improvement

• Follow HIPAA, CMS, Medi-Cal, California payer requirements, commercial payer rules, and organizational policies.
• Assist with account audits, medical record requests, subpoenas, and payer inquiries.
• Monitor work queues, productivity, AR aging, denial trends, reimbursement barriers, and other revenue cycle metrics.
• Participate in process improvement initiatives designed to reduce denials, improve clean claims, accelerate collections, and enhance the patient billing experience.
• Stay current on payer requirements, regulatory changes, and revenue cycle best practices.

What We're Looking For

Required

• High school diploma or GED.
• At least 3 years of experience in healthcare revenue cycle, medical billing, accounts receivable, insurance follow-up, denial management, payment posting, patient billing, or a related business office function.
• Epic Resolute Professional Billing experience required.
• Experience working with commercial and government payers, including Medi-Cal managed care, workers' compensation, and third-party administrators.
• Experience interpreting EOBs, ERAs, payer correspondence, denial notices, payer portals, clearinghouse rejections, appeal requirements, and timely filing rules.
• Strong understanding of the healthcare revenue cycle.
• Strong analytical, organizational, problem-solving, written, and verbal communication skills.
• High level of accuracy, attention to detail, confidentiality, and accountability.

Preferred

• Associate degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field.
• Experience with Epic/CareConnect work queues, claims, remittance, guarantor accounts, patient billing, and reporting workflows.
• Experience in an ambulatory surgery center, specialty clinic, orthopedic, urgent care, infusion, 340B, factor, or multi-specialty practice.
• Certification such as CPB, CCA, CPC, CRCR, or an equivalent revenue cycle certification.

Why This Role Matters

Revenue Cycle is more than submitting claims. It's about making sure services are billed accurately, payments are received timely, accounts are resolved correctly, and patients receive clear and professional support when they have questions about their bills.

We're looking for someone who can own their work, dig into complex accounts, identify problems, and follow issues through to resolution.

Work Environment

This position works in a professional healthcare/business office environment and requires regular use of computers, electronic medical record systems, payer portals, clearinghouse tools, telephones, and secure communication platforms.

Equal Opportunity

We are committed to providing an inclusive workplace and equal employment opportunities to qualified individuals. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.