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POSITION SUMMARY

The Revenue Cycle Specialist is responsible for the review, analysis, follow-up, and resolution of third-party claims reimbursements, ensuring timely billing, collection, and payment of professional and institutional healthcare claims. The Revenue Cycle Specialist actively collaborates with internal departments to maximize reimbursement, reduce outstanding accounts, and maintain compliance with payer contracts and regulatory guidelines.

PRIMARY ACCOUNTABILITES 1.

Reviews and processes professional and institutional claims to ensure accurate and timely reimbursement. 2. Investigates and resolves claim denials, underpayments, and payment discrepancies with thirdparty payers. 3. Monitors and analyzes reimbursement trends, identifying issues that impact revenue and implementing corrective actions. 4. Engages with insurance companies, government payers, and vendors to verify benefits, submit appeals, and secure payments. 5. Updates and maintains patient accounts and billing systems with accurate payment and denial information. 6. Communicates payer trends, delays, and discrepancies to leadership and assists in developing solutions. 7. Ensures compliance with state, federal, and payer-specific regulations related to claim processing and reimbursement. 8. Assists in the training and mentoring of new hires to ensure adherence to applicable department standards and processes. 9. Collaborates with internal departments such as Coding and Documentation, Patient Financial Services, and Patient Registration to resolve claim issues and improve workflow. 10. Promotes productivity and quality assurance benchmarks to support Revenue Cycle efficiency and financial goals.