Revenue Cycle Specialist Position Summary The Revenue Cycle Specialist supports the full life cycle of a claim—from registration and eligibility through charge capture, claim submission, payment posting, denial resolution, and account resolution. Working out of the Central Business Office , this role owns assigned payer and provider queues, drives down aged accounts receivable, and identifies the upstream causes of denials and underpayments to help prevent recurring issues. Key ResponsibilitiesAccounts Receivable & Follow-Up Work assigned A/R queues by payer, aging bucket, and dollar threshold, prioritizing high-value accounts and those at risk of timely-filing deadlines. Contact payers through portals, phone, and EDI to determine claim status and resolve outstanding balances. Document all account activity, payer responses, and required next steps in the practice management system. Denials & Appeals Research, categorize, and resolve denials and underpayments; determine root causes and route necessary corrections. Prepare and submit appeals with supporting clinical and administrative documentation within payer deadlines. Track denial trends by payer, provider, and reason code and report findings to leadership. Charge Capture & Claim Integrity Review charges, coding, and demographic information for accuracy prior to claim submission. Correct claim edits, errors, and rejections. Coordinate with front-end teams to address eligibility, authorization, and registration issues contributing to downstream denials. Payment Posting & Reconciliation Post and reconcile ERA/EOB payments, adjustments, and contractual write-offs as assigned. Identify variances between actual and expected reimbursement based on payer contract terms. Escalate reimbursement discrepancies as appropriate. Patient & Internal Support Respond to patient billing inquiries and establish payment arrangements in accordance with company policy. Partner with provider offices and internal departments to resolve account questions and process-related issues. Reporting & Compliance Meet established daily and weekly productivity and quality standards. Contribute to KPI reporting, including: Days in A/R Clean claim rate Denial rate Net collection rate Maintain strict HIPAA compliance and adhere to all payer and company policies. Required Qualifications High school diploma or equivalent required; associate's or bachelor's degree preferred. 2+ years of medical revenue cycle experience spanning billing, A/R follow-up, and denial management.

Working knowledge of:

CPT HCPCS ICD-10

Modifiers CMS-1500 and UB-04 claim forms Standard denial and remark codes Familiarity with New York Medicaid, Medicare, managed care, and commercial payer requirements . Experience with practice management systems, EHR platforms, and clearinghouse systems such as: Availity Waystar Change Healthcare / Optum TriZetto Proficiency in Microsoft Excel and comfort working from reports, worklists, and account queues. Strong analytical skills and attention to detail. Ability to independently manage a large account inventory and prioritize workload effectively. Preferred Qualifications Experience working in a centralized business office or multi-specialty/multi-provider environment. CRCR, CPB, CPC, or comparable revenue cycle certification. Exposure to payer contract terms and expected reimbursement analysis. Experience identifying and implementing process improvements that reduce denials or shorten collection cycles. Physical & Work Requirements On-site position in a standard office environment.

Pay:

$75,000.00 - $85,000.00 per year

Benefits:

401(k) Health insurance Paid time off People with a criminal record are encouraged to apply Application Question(s): Do you have Working knowledge of medical billing and coding? Do you also understand CPT, HCPCS, ICD-10, modifiers, CMS-1500/UB-04, denial codes, and remark codes. Do you have experience with the below: Experience working with major healthcare payers experience with Medicare, Medicaid, managed care, and commercial insurance. New York Medicaid experience is strongly preferred and should be required if this role will primarily support NY accounts.

Experience:

of hands-on medical revenue cycle e: 2 years (Required) with billing, A/R follow-up, and denial management: 2 years (Required)

Work Location:

In person