Revenue Cycle Management Specialist

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Assist in achieving account performance excellence by collaborating with Hyderabad transactional teams.

• Prepare and submit medical-service claims to insurance providers and patients.

• Gather necessary documentation, such as medical records, EOBs, remittances, authorizations, and referrals.

• Assess denied physician billing claims, confirm coding accuracy, make amendments, and liaise with insurers to resolve and recover denied claims.

• Monitor aging reports and follow up on outstanding claims.

• Evaluate registration data retrospectively to facilitate clean claim submissions.

• Record claim actions and resolutions within patient accounts and claims.

• Address issues related to registration, demographics, insurance, claims, and accounts.

• Work collaboratively with cross-functional teams, including managers, coders, billing managers, and practice staff.

• Communicate resolutions of client issues and report monthly KPI trends.

• Adhere to HIPAA confidentiality standards and compliance policies.

• Verify billing and coding accuracy before submitting appeals or reconsiderations.

• Identify trends in denials and enhance conversion rates by preventing errors.

• Stay updated on compliance and regulatory changes.

• Contribute to process and quality improvement initiatives.

• Achieve supervisor-defined objectives for error-free operations, transactions, processes, and compliance.

• Deliver customer service to patients and insurers, including handling calls and responding to information requests.

• Generate reports for management and communicate resolutions related to payment, coding, and billing issues.

• Identify missing payments, overpayments, and account credits.

• Reconcile deposit logs with posting reports.

• Maintain precise reimbursement records and perform other assigned responsibilities.

⛳️ Requirements

• A minimum of 3-5 years of experience in a Physician Billing department, specifically in handling denials, appeals, insurance collections, and related follow-ups is mandatory.

• Experience with Medicaid, particularly AZ Medicaid.

• Comprehensive understanding of the complete claim cycle, encompassing charge/claim submission, payments, and accounts receivable.

• Ability to apply contract language with a thorough understanding of claims denial appeal logic.

• Extensive experience utilizing search engines and the Internet.

• Proficient in effectively using payer websites.

• Knowledge and proficiency with Microsoft products, including Outlook, Word, and Excel.

• Familiarity with and competency in HIPAA compliance.

• Understanding of accepted healthcare insurance billing practices.

• Strong written and verbal customer service and communication abilities.

• Excellent reasoning, critical thinking, analytical, and mathematical skills.

• Capability to work independently, adapt flexibly between broad and detailed tasks, maintain high productivity, and consistently meet deadlines.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Competitive salary with performance bonuses.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on teamwork.

• Flexible work hours to promote work-life balance.