Revenue Cycle Specialist

Streamline Claims. Ensure Accuracy. Support Quality Care. We are seeking a detail-oriented and highly organized Revenue Cycle Specialist to support our billing operations through timely processing of Government and Commercial claims. This role plays a vital part in maintaining accurate medical records, identifying payer trends, and ensuring billing compliance across all areas of the revenue cycle. The ideal candidate will have experience in home health or hospice billing, with a strong understanding of payer systems and reimbursement processes.

Key Responsibilities:

Process assigned Medicare, Medicaid, and/or Commercial claims and payments accurately and within payer timelines. Track daily documentation for physician orders and signatures. Notify administration of missing documents and maintain patient medical records. Maintain required logs, rosters, and documentation records. Identify payer behavior trends and report unexpected patterns to the Revenue Cycle Manager. Participate in quality improvement activities related to billing performance. Communicate professionally with field staff regarding documentation and unbilled revenue. Follow up on outstanding billing items and understand clearinghouse edits and electronic billing rejections. Review and interpret Explanation of Benefits (EOBs) to determine next steps in payment posting or appeals.

Skills and Qualifications:

Excellent troubleshooting and problem-solving skills. Strong understanding of revenue cycle operations and medical billing workflows. Comfortable managing a high volume of claims in a metrics-driven environment. Ability to work with confidential data and maintain accuracy in data entry. Capable of working independently and collaborating with cross-functional teams. Skilled at using multiple computer applications and clearinghouse platforms. Familiarity with payer guidelines, filing limits, and billing edits. Strong verbal and written communication skills for engaging with clinical staff. Flexible and responsive to departmental and organizational needs.

Education and Experience:

Must be at least 18 years old with a high school diploma or GED. Minimum of 2 years of experience in Home Health or Hospice billing required.

Technical Requirements:

Advanced Microsoft Office skills, including basic to advanced Excel capabilities. Experience with Homecare HomeBase preferred. Experience with billing tools such as DDE, E-solutions, Waystar, and/or Nthrive is a plus.