Revenue Cycle Specialist

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

📋 Description

• Review and process claims through various stages of the revenue cycle efficiently and in compliance with regulations.

• Monitor client performance to identify potential revenue losses or delays, ensuring maximum reimbursement.

• Propose solutions aimed at enhancing client performance, workflows, processes, and results.

• Provide proactive insights on client performance, industry updates, payer regulations, and potential concerns.

• Engage with payers to pinpoint deficiencies and relay feedback to operational staff.

• Prioritize, process, and delegate correspondence, including rejections, denials, appeals, static claims, and other follow-up actions.

• Assess and determine the suitable next steps for each claim.

• Identify problems, ascertain causes, and independently initiate and complete resolutions.

• Collaborate and communicate with Claims Management supervisors and both onshore and offshore team members.

• Ensure effective prioritization of tasks while adhering to standard operating procedures and vendor SLAs.

• Monitor and evaluate client performance against commitments, addressing any barriers to achieving desired outcomes.

• Stay updated on industry changes and regulatory developments.

• Build and sustain relationships, both internal and external, to meet client needs.

• Present analyses of client performance as directed.

• Act as a backup for other team members when necessary.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School Diploma.

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

• Ability to apply big-picture analysis, critical thinking, lean methodologies, innovation, curiosity, tenacity, and consistent, timely follow-through.

• Capability to organize, prioritize, and manage multiple tasks simultaneously.

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

• Dedication to continuous improvement.

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

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

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

• Strong critical thinking, analytical abilities, and attention to detail.

• Proficiency in Microsoft Office suite.

• Proficiency in English for job-related communications.

• Preferred: previous experience in EMS billing and/or handling denials.

• Preferred: familiarity with EMS|MC billing software.

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

🏝️ Benefits

• Discretionary bonus plan.

• Comprehensive benefits package.

• Retirement plan.

• Health coverage.

• Paid time off.

• EMS|MC-provided computer, monitor, keyboard, mouse, and headset.

• Reasonable accommodations for qualified individuals with disabilities.