Revenue Cycle Specialist
Fully Remote Winston Salem, NC Revenue Cycle
Job Type

Job Summary

Review and process claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

Major Responsibilities/Activities

  • Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance
  • Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff
  • Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues 
  • Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim
  • Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion
  • Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs 
  • Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
  • Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
  • Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness 
  • Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs
  • Conduct all job tasks, calls, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations
  • Consistently support and demonstrate the company mission and values

Other Responsibilities/Activities

  • Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
  • Serve as backup to other teams members as required
  • Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager 


Performance Requirements

  • Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service Level Agreements, A/R Aging, Net Collection Percentages, Average Cash Per Trip, Denials, Rejections, Account Review Aging, and maintaining a 96% audit score monthly. 

Required Education, Skills, & Experience

  • High School Diploma
  • At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience
  • Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though 
  • Ability to organize, prioritize and multi-task  
  • Ability to learn, understand, and work within specific compliance, client, and payer requirements
  • Approach all tasks, duties, and interactions with an attitude of continuous improvement
  • Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
  • Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
  • Ability to function well within a cross-functional team setting and independently
  • Detail-oriented
  • Resourceful
  • Self-starter
  • Must possess critical thinking/analytical skills
  • Proficient in Microsoft Office programs

Preferred Education, Skills, & Experience

  • Strong preference for prior EMS billing and/or denials experience
  • Proficient in EMS|MC billing software

Working Environment/Physical Requirements

  • General office environment
  • Frequent typing
  • Sitting, standing, walking
  • Use of basic office equipment such as computer, fax, printer, copier, and telephone