Revenue Cycle Specialist

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

📋 Description

• Reconcile ERA/EOB payments with anticipated reimbursements; identify and address underpayments, overpayments, and missing remittances.

• Investigate and resolve payment posting flags within the billing system.

• Maintain accounts receivable aging across assigned payer relationships, managing work buckets by age and priority.

• Communicate directly with payer representatives to resolve disputes regarding outstanding balances.

• Coordinate with our RCM platform team on shared accounts receivable workqueues, tracking responsibilities between the platform and internal handling.

• Conduct pre-submission claim scrubbing to identify errors in demographics, eligibility, authorization, coding completeness, and payer-specific requirements before submission.

• Verify patient eligibility and benefits with assigned payers before claims are submitted.

• Validate prior authorization requirements and ensure authorization numbers are accurately documented on claims.

• Identify recurring pre-submission error trends and report them to the RCM Manager, along with recommendations for upstream workflow improvements.

• Resolve claim rejections from our RCM platform and payer portals, including 277 rejection reports and real-time rejection queues.

• Differentiate between clearinghouse-level and payer-level fixes, coordinating with the platform team as necessary.

• Maintain a rejection tracking log, categorizing by error type, payer, and root cause.

• Collaborate with Denial Specialists to prevent upstream rejections from reappearing as downstream denials.

⛳️ Requirements

• A minimum of 3 years of medical billing experience covering at least two of the three core functions: accounts receivable reconciliation, claim submission/quality assurance, or rejection management.

• Ability to manage multiple work queues concurrently and re-prioritize based on aging and volume.

• Experience with ERA/EOB reconciliation at a volume level, including payer-level batch reconciliation rather than just individual claims.

• Familiarity with 837 claim files, 277 rejection reports, and ERA/835 remittance files.

• Knowledge of Medicaid managed care and Medicare Advantage payer requirements.

• Proficiency in clearinghouse and RCM platforms; experience with leading billing platforms is advantageous but not mandatory.

🏝️ Benefits

• Health insurance.

• Flexible work arrangements.