Revenue Cycle Specialist II

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

📋 Description

• Verify insurance eligibility and benefits ahead of scheduled surgical procedures.

• Review, submit, and monitor surgical authorization and pre-certification requests.

• Communicate with insurance providers through payer portals and phone to secure approvals, authorizations, predeterminations, and referrals.

• Interpret payer medical policies and clinical guidelines to validate medical necessity.

• Calculate and convey estimated patient financial responsibilities before surgery.

• Track authorization requests until final determination and follow up on outstanding cases.

• Collaborate with clinical staff, surgery schedulers, and revenue cycle teams to address authorization issues or denials.

• Assist in escalation cases, including coordinating peer-to-peer reviews when necessary.

• Document authorization activities and payer communications in the EMR/EPM system.

• Address patient inquiries concerning insurance benefits, authorizations, and surgery-related expenses.

• Ensure compliance with payer requirements, healthcare regulations, and internal processes.

• Manage a substantial workload while ensuring accuracy, attention to detail, and excellent customer service.

• Perform other related duties as assigned.

⛳️ Requirements

• High School Diploma or an equivalent qualification.

• A minimum of 3 years of recent experience in surgical authorization, insurance verification, or healthcare revenue cycle.

• Proficiency in CPT, ICD-10, and HCPCS coding, including modifiers.

• Strong understanding of insurance authorization processes and payer websites/portals.

• Ability to read and interpret medical records and Explanations of Benefits (EOBs).

• Excellent organizational skills with the capacity to manage multiple priorities and deadlines.

• Outstanding verbal and written communication abilities.

• Proficient in Microsoft Office and electronic medical record (EMR/EPM) systems.

• Capability to work both independently and collaboratively in a fast-paced, high-pressure environment.

• Ability to sit for extended periods, navigate the office as required, and perform light lifting.

• Manual dexterity is necessary for frequent computer and phone usage.

• Strong attention to detail and accuracy.

• Good leadership, interpersonal, and communication skills.

🏝️ Benefits

• Fully remote work arrangement.

• Monday–Friday daytime schedule.

• Occasional after-hours meetings may be required.