Revenue Cycle Specialist

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

📋 Description

• Ensure precise billing and prompt submission of both electronic and paper claims.

• Track claim statuses and investigate as well as resolve denials or rejections.

• Record account activities and manage adjustments and collections.

• Identify and assess denial patterns while proposing process and system enhancements.

• Investigate and resolve unpaid, denied, and rejected claims, including liaising with payers and resubmitting denials as necessary.

• Manage EDI transactions, including the reconciliation of payer submissions, edits, and rejection reports.

• Collaborate with the Insurance Verification team to pinpoint upstream impacts on claim processing.

• Work alongside team members and other departments to align with organizational objectives and implement process enhancements.

• Perform collection activities in accordance with payer guidelines and filing limitations, ensuring thorough documentation of actions.

• Review posted payments and process account adjustments when appropriate.

• Monitor patient accounts for non-payment, delayed payments, and billing discrepancies.

• Investigate and address patient billing inquiries.

• Operate under the guidance of the Supervisor of Revenue Cycle Management.

⛳️ Requirements

• High school diploma or GED is required.

• A minimum of 3 years of experience in Revenue Cycle Management (RCM), with a strong preference for knowledge in accounts receivable processes.

• Capability to analyze claims data to identify trends and propose mitigation strategies.

• Experience in digital or virtual health settings is preferred.

• Familiarity with medical billing systems (e.g., Candid Health, Healthie).

• Extensive background in healthcare accounts receivable and collections.

• Exceptional attention to detail with a strong focus on accuracy and prioritization.

• Excellent verbal and written communication skills for engaging with internal and external stakeholders.

• Demonstrated customer service skills in resolving inquiries from patients and payers.

• Working knowledge of medical coding principles, denial management, and payer-specific requirements.

• Ability to succeed in a fast-paced, high-volume work environment.

• Dedication to adhering to HIPAA and regulatory compliance standards.

• Comprehensive understanding of Medicaid, Medicare, and commercial insurance billing processes.

• Preferred: Experience in mental or behavioral health billing.

• Preferred: Proficiency in Spanish.

• Preferred: Skilled in Microsoft Excel and Word.

🏝️ Benefits

• Full-time, 100% remote position.

• Monday–Friday work schedule.

• Equal opportunity employer.

• Diverse and inclusive workplace.