The Revenue Cycle Specialist is responsible for the company's third-party medical claims processing and submission. The work completed by the revenue cycle specialist directly affects the collection of revenue for the organization. This role works within the computerized claims management system for the validation, submission, and processing of insurance and self-pay claims.

Required Qualifications:

High School Diploma Minimum one (1) year experience in insurance, healthcare, or customer service field.

Preferred Qualifications:

Previous experience with healthcare billing, follow-up, and collections.

Essential Duties and Responsibilities:

Enters necessary information for insurance claims (i.e. patient demographic data, insurance id, diagnosis, treatment codes, modifiers, and provider information. Submit claims to clearinghouse or individual payers electronically or via paper

CMS-1500

form or UB-04. Follows up with payers either through a phone call or website on unpaid or rejected claims. Ensures claim information is accurate and complete. Resolve claim errors and resubmit for payment.

Other Functions:

Performs special projects as needed and assigned. Performs other duties as assigned.