Revenue Cycle Specialist

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

📋 Description

• Review and manage claims through various phases of the revenue cycle promptly and in accordance with regulations.

• Track client performance to detect potential revenue losses or delays.

• Explore and propose solutions to enhance reimbursement and client performance.

• Provide insights on client performance, workflows, processes, trends, industry developments, payer regulations, and issues.

• Proactively communicate with payers to pinpoint deficiencies and assist in resolving and preventing issues.

• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and other follow-ups on claims.

• Assess the appropriate next steps for each claim and ensure issues are followed through to resolution.

• Collaborate and communicate with the Supervisor of Claims Management and both onshore and offshore team members.

• Secure reimbursement through effective work prioritization and adherence to standard operating procedures and vendor service level agreements (SLAs).

• Evaluate client performance outcomes relative to commitments and identify obstacles to achieving desired results.

• Stay updated on industry shifts and regulatory changes.

• Cultivate and maintain relationships with both internal and external customers.

• Present client performance analyses as required.

• Act as a backup for other team members.

• Execute other assigned duties and tasks.

⛳️ Requirements

• High School Diploma.

• Minimum of 1–2 years of experience in processing health insurance claims and/or denials, or other healthcare accounts receivable experience, or 1–2 years of medical billing experience, or at least 1 year of EMS billing experience.

• Capability to analyze client performance using big-picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and timely follow-through.

• Skill in organizing, prioritizing, and multitasking.

• Ability to learn, comprehend, and operate within compliance, client, and payer requirements.

• Dedication to continuous improvement.

• Knowledge of relevant HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods.

• Flexibility to adapt to changes in the work environment, procedures, priorities, and responsibilities.

• Ability to work effectively both within a cross-functional team and independently.

• Strong critical-thinking and analytical abilities with keen attention to detail.

• Proficiency in Microsoft Office applications.

• Proficiency in English for job-related communication.

• Strong preference for prior EMS billing and/or denials experience.

• Proficiency in EMS|MC billing software.

• Authorization to work in the United States, both now and in the future; no current or future visa sponsorship.

🏝️ Benefits

• Discretionary bonus plan.

• Comprehensive benefits package.

• Retirement plan.

• Health coverage.

• Paid time off.

• EMS|MC provides necessary equipment, including a computer, monitor, keyboard, mouse, and headset.

• Reasonable accommodations for qualified individuals with disabilities.