Revenue Cycle Specialist

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

📋 Description

• Oversee and resolve pending claims within specified deadlines

• Follow a systematic weekly schedule for claim resolution

• Evaluate account trends and enhance workflows

• Address high-dollar, aged, and minor accounts

• Communicate with payers regarding denials, rejections, payment delays, and discrepancies

• Track and escalate unresolved or complicated claims

• Complete necessary correspondence and submit required documentation and medical records to payers

• Prepare and dispatch weekly appeals via certified mail

• Accurately document claim activities and interactions with payers

• Keep records of high-dollar claims, appeals, and correspondence

• Provide supervisors with updates on claim statuses, trends, and unresolved matters

• Engage in audits and quality assessments

• Collaborate with revenue cycle team members and escalate cases to the AR Supervisor/Manager

• Identify delinquent accounts, aging periods, and payment sources

• Investigate insurance credit balances and request refunds

• Appeal claims that were incorrectly processed and make necessary adjustments

• Refile primary paper and secondary claims

• Assist secretaries and patients with insurance-related issues and inquiries

• Manage incoming insurance correspondence and scan documents into the practice management system

• Negotiate payments with non-contracted insurance payers

• Attend mandatory insurance training seminars/webinars

• Participate in appeals hearings as needed

• Uphold privacy, confidentiality, and security of organizational data

• Post office and ancillary procedure charges

• Balance charge totals and communicate with physician staff for corrections

• Follow up on holds and clear tickets within designated timeframes

• Correct demographic information and ensure clean claims are submitted

• Collect patient payments and offer alternative payment plans

• Answer business office phone lines and handle calls

• Update financial and demographic data

• Interact with collection agencies and manage bankruptcy and deceased patient accounts

• Process patient receipts and identify/process patient refunds

• Attend staff meetings and contribute to special committees

• Perform additional duties and assignments as needed

⛳️ Requirements

• Must reside in the state of Arizona

• Process claims within 5 business days of submission

• Prioritize and process high-dollar claims ($5,000) within 5 business days

• Comply with federal, state, and payer regulations

• A minimum of two years of prior experience in a private practice or hospital billing/business office is preferred

• Experience in insurance billing utilizing CPT, ICD-10, and modifier coding is preferred

• High school diploma or G.E.D. is required

• Ability to analyze payment denials and draft letters of appeal

• Willingness to undergo cross-training in all areas of the Business Office

• Capability to identify account issues and explain them effectively to patients

• Strong communication skills with staff, patients, insurance companies, outside physician offices, and physicians

• Ability to work independently while completing tasks accurately and on time

• Consistent attendance without excessive tardiness

• Professional demeanor and appropriate attire

🏝️ Benefits

• Overtime as required