Revenue Cycle Specialist

Description:

The Revenue Cycle Specialist is responsible for managing billing and reimbursement processes to ensure timely and accurate payment for medical services. This role supports the full revenue cycle, from charge entry and claim submission through payment posting and follow-up, while maintaining compliance with payer and regulatory requirements. Key Responsibilities Review, prepare, and submit medical claims to commercial insurers, Medicare, Medicaid, and other payers Ensure accurate coding, charge entry, and claim documentation in accordance with payer guidelines Monitor claim status and follow up on unpaid, denied, or underpaid claims Investigate and resolve billing errors, denials, and discrepancies Post payments, adjustments, and refunds accurately to patient accounts Communicate with insurance companies regarding claim status and reimbursement issues Work collaboratively with front office, clinical staff, and coding teams to resolve billing issues Maintain compliance with HIPAA, payer policies, and applicable regulations Generate and review billing and aging reports to support revenue cycle performance Assist with patient billing inquiries as needed

Requirements:

Required Qualifications High school diploma or equivalent (associate degree preferred) 1-3 years of medical billing or revenue cycle experience (clinic or healthcare setting) Knowledge of insurance billing processes and reimbursement methodologies Familiarity with CPT, ICD-10, and HCPCS coding concepts Proficiency with electronic health records (EHR) and practice management systems Strong attention to detail and organizational skills Preferred Qualifications Experience with multi-payer environments (commercial, Medicare, Medicaid) Knowledge of denial management and appeals processes Medical billing or coding certification (e.g., CPB, CPC) Experience in a specialty clinic (if applicable) Key Skills and Competencies Analytical and problem-solving skills Effective written and verbal communication Time management and ability to prioritize workloads Ability to work independently and as part of a team Commitment to accuracy, confidentiality, and compliance