Revenue Operations Specialist

Job Description

Job Description

We are hiring for a CPAC Revenue Operations Specialist supports revenue-cycle and patient-account activities.

This position is responsible for reviewing and processing healthcare billing and reimbursement information, maintaining accurate patient and insurance data, resolving account discrepancies, and ensuring documentation complies with applicable policies and procedures.

The ideal candidate will have strong attention to detail, excellent organizational skills, and experience working with healthcare billing, patient accounts, insurance, medical records, or revenue-cycle operations.

Key Responsibilities

• Review and process patient account and revenue-cycle information for accuracy and completeness.
• Research and resolve discrepancies involving patient accounts, insurance, billing, payments, and reimbursements.
• Review medical and administrative documentation to support accurate billing and collection activities.
• Verify patient demographics, insurance coverage, eligibility, and third-party payer information.
• Process and maintain accurate account information within applicable systems.
• Research rejected, denied, or unresolved claims and coordinate appropriate corrections.
• Communicate with medical centers, healthcare providers, insurance companies, patients, and other stakeholders as needed.
• Maintain accurate documentation and records while protecting sensitive patient information.
• Monitor assigned workload and meet established productivity, quality, and turnaround requirements.
• Identify recurring issues and recommend process improvements to increase accuracy and efficiency.
• Follow policies, procedures, HIPAA requirements, and applicable federal regulations.
• Provide administrative and operational support to CPAC revenue operations as assigned.

Required Qualifications

• Experience in healthcare administration, medical billing, patient accounts, insurance, revenue cycle, or related healthcare operations.
• Strong computer and data-entry skills.
• Experience working with electronic healthcare or financial systems.
• Excellent attention to detail and ability to identify discrepancies.
• Strong written and verbal communication skills.
• Ability to handle confidential patient and financial information.
• Ability to work independently while managing multiple priorities and deadlines.

Preferred Qualifications

• Previous experience supporting the federal healthcare organization.
• Experience with CPAC, revenue operations, medical billing, third-party collections, or healthcare revenue cycle management.
• Knowledge of healthcare systems and revenue processes.
• Experience with medical coding, claims processing, insurance verification, or denial management.
• Familiarity with VistA, CPRS, or other government information systems.

Revenue Cycle & Insurance Verification Program Manager / Operations Lead

Position Overview

We are seeking an experienced Revenue Cycle & Insurance Verification Program Manager / Operations Lead to oversee and support healthcare insurance verification and revenue cycle operations. The ideal candidate will have direct, hands-on experience with insurance eligibility verification, third-party insurance entry, benefits coordination, and high-volume healthcare administrative workflows.

This role requires a candidate who can demonstrate strong knowledge of healthcare insurance processes, maintain data accuracy, resolve exceptions, and effectively manage operational workflows.

Key Responsibilities

• Oversee and support high-volume insurance eligibility and benefits verification activities.
• Manage processes for identifying, entering, validating, and updating third-party insurance information.
• Ensure accurate insurance sequencing and coordination of benefits (COB).
• Monitor insurance verification workflows to identify missing, incomplete, or inaccurate information.
• Research and resolve insurance verification rejections, discrepancies, exceptions, and processing issues.
• Ensure timely correction and completion of insurance-related transactions.
• Monitor productivity, quality, accuracy, and workflow turnaround times.
• Develop and maintain procedures and workflow controls to improve accuracy and efficiency.
• Provide guidance, training, and operational support to staff performing insurance verification and revenue cycle functions.
• Review work for compliance with established healthcare, payer, and organizational requirements.
• Coordinate with patient access, billing, coding, accounts receivable, clinical, and other revenue cycle teams.
• Analyze workflow issues and recommend process improvements to reduce errors, rework, and delays.
• Prepare operational reports and communicate performance, trends, and issues to leadership.
• Support implementation and maintenance of standardized processes across teams.
• Maintain strict confidentiality and security of patient and insurance information.

Required Qualifications

• Bachelor's degree in healthcare administration, business, health information management, or a related field preferred; equivalent healthcare revenue cycle experience may be considered.
• 5+ years of healthcare revenue cycle, insurance verification, patient access, or healthcare administrative operations experience.
• Demonstrated hands-on experience with:
• Insurance eligibility verification
• Third-party insurance identification and entry
• Insurance sequencing
• Coordination of benefits
• Insurance data validation and updates
• Rejection and exception resolution
• Experience working in a high-volume healthcare environment.
• Experience overseeing teams, workflows, or operational functions is strongly preferred.
• Strong analytical, organizational, problem-solving, and communication skills.
• Ability to work with sensitive patient and financial information while maintaining strict confidentiality.

Preferred Qualifications

• Experience with commercial EHR and healthcare insurance systems.
• Experience with Medicare, Medicaid, TRICARE, commercial insurance, or other third-party payer systems.
• Revenue cycle or healthcare administration certification.
• Experience managing distributed or geographically dispersed teams.
• Experience developing, implementing, or improving healthcare revenue cycle processes.

Ideal Candidate Profile

The strongest candidate will be someone who has progressed from hands-on insurance verification or revenue cycle operations into a supervisory, management, program management, or operations leadership role.

Candidates may come from backgrounds such as:

• Revenue Cycle Manager
• Revenue Cycle Operations Manager
• Insurance Verification Manager
• Insurance Verification Supervisor
• Patient Access Manager
• Eligibility & Benefits Manager
• Patient Financial Services Manager
• Healthcare Operations Manager
• Revenue Operations Lead
• Healthcare Program Manager

Apply today!