Revenue Specialist

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

📋 Description

• Verify patient eligibility as necessary.

• Analyze and assess Medicaid claim payments utilizing company systems and tools.

• Evaluate reimbursement compliance with relevant state fee schedules.

• Research, request, and obtain medical records and necessary documentation.

• Submit hospital claims along with required documentation for timely reimbursement.

• Review and amend UB-04 billing elements in accordance with billing regulations.

• Conduct follow-up calls with payers regarding claims and documentation.

• Prepare and send Medicaid initial billing packets with supporting documentation.

• Analyze account delinquencies and activities to ensure prompt and accurate payments.

• Verify or request authorizations and assist with concurrent review activities.

• File and manage confidential documents and PHI while adhering to HIPAA guidelines.

• Handle incoming and outgoing calls.

• Collaborate to optimize workflow within the department as part of a team.

• Appeal claim denials and underpayments.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• An Associate's or Bachelor’s Degree is preferred.

• 1-2+ years of experience in healthcare billing or collections.

• 1+ years of client-facing or customer service experience.

• 1+ years of experience with UB-04 billing and collections is required.

• CMS-1500 billing and experience with other complex claims is a plus.

• Intermediate understanding of insurance payer/provider claims processing and related data requirements.

• Intermediate knowledge of Medicaid payers is preferred.

• An equivalent combination of education and experience will be considered.

• Strong computer skills and knowledge of basic office applications, including MS Office (Word, Excel, and Outlook).

• Regular and consistent attendance is expected.

• Ability to meet or surpass productivity targets and goals.

• Capability to maintain stable performance under pressure.

• Self-motivated individual able to work independently without direct supervision.

• Proven written and verbal communication abilities.

• Strong analytical and problem-solving skills.

• Experience collaborating with external clients; strong customer service skills and business acumen.

• Ability to prioritize and manage multiple competing priorities and projects simultaneously.

• Ability to remain in a stationary position for 50% of the time.

• Ability to continuously operate a computer and office equipment.

• Must handle PHI in compliance with HIPAA privacy and security requirements.

🏝️ Benefits

• Full-time employment.

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• Flexible, family-oriented work environment.

• Support for work-life balance.

• Option for remote work.

• Equal opportunity workplace free from discrimination and harassment.