Revenue Cycle Specialist

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

📋 Description

• Evaluate, resolve, and manage Air client claims throughout the revenue cycle efficiently, accurately, and in compliance with regulations.

• Oversee assigned client accounts and claims inventories to identify revenue risks, reimbursement delays, aging trends, and opportunities for performance improvement.

• Prioritize and address pending, rejected, denied, underpaid, stalled, and aged claims, particularly those exceeding 120 days.

• Handle claims for commercial insurance, TRICARE, workers’ compensation, VA, Medicare, Medicaid, and various government-funded programs.

• Reach out to payers and utilize approved portals to confirm claim status, eligibility, benefits, payment details, filing requirements, and necessary follow-up actions.

• Collect medical records and supporting documentation, engaging with patients or authorized representatives as needed.

• Prepare and submit claim corrections, reconsiderations, and appeals, including verbal appeals when appropriate.

• Investigate underpayments, overpayments, payment discrepancies, and outstanding balances; prepare refund documentation when necessary.

• Identify account issues and their root causes, resolve matters within authority, and escalate complex or unresolved issues.

• Track client outcomes in relation to productivity, quality, turnaround time, operating procedures, and service-level standards.

• Relay payer trends, recurring deficiencies, workflow obstacles, client concerns, and opportunities for improvement to operational and management teams.

• Collaborate with both onshore and offshore team members and cross-functional revenue cycle partners.

• Stay informed about payer policies, prompt-payment requirements, regulatory changes, and Air client-specific procedures.

• Provide professional service and foster positive relationships with payers, clients, patients, leaders, and colleagues.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• High school diploma or equivalent qualification.

• One to two (1-2) years of experience in medical billing, insurance follow-up, denials management, healthcare accounts receivable, or claim resolution; one (1) year of EMS billing experience may substitute for the broader experience requirement.

• Basic understanding of healthcare revenue cycle processes, insurance benefits, payer types, claim status follow-up, denials, underpayments, correspondence, and appeals.

• Capability to learn, interpret, and implement payer requirements, client procedures, compliance standards, prompt-payment guidelines, and filing and appeal deadlines.

• Familiarity with HIPAA requirements and the ability to safeguard confidential patient and client information.

• Excellent analytical, critical-thinking, and problem-solving abilities.

• Strong attention to detail and the ability to document account activities clearly, accurately, and comprehensively.

• Exceptional organizational and time-management skills, with the ability to prioritize multiple work queues and deadlines.

• Proficient written and verbal communication and customer service skills.

• Ability to work both independently and in collaboration with cross-functional, onshore, and offshore teams.

• Flexibility to adapt to evolving payer requirements, client needs, systems, procedures, priorities, and responsibilities.

• Proficient in Microsoft Office applications.

• Skillful in navigating billing systems, document-management tools, payer portals, and multiple applications efficiently.

• Proficiency in English is essential for job-related communication.

• Preferred: experience in supporting air medical, emergency medical services, ambulance billing, or another complex healthcare revenue cycle environment.

• Preferred: experience with commercial insurance, TRICARE, workers' compensation, VA, Medicare, Medicaid, or other government payer claim follow-up.

• Preferred: experience in medical insurance collections, denials, appeals, medical terminology, and aged accounts.

• Preferred: proficiency in EMS|MC billing software or a similar ambulance billing platform.

• Must be authorized to work in the United States currently and in the future; no current or future visa sponsorship provided.

🏝️ Benefits

• Discretionary bonus plan.

• Retirement plan.

• Health coverage.

• Paid time off.

• Comprehensive benefits package.

• Necessary equipment provided, including computer, monitor, keyboard, mouse, and headset.

• Reasonable accommodations for qualified individuals with disabilities.

• Quiet, private workspace requirement for approved hybrid or remote employees.

• Reliable internet connection required for hybrid/remote work.