Revenue Specialist

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

📋 Description

• Validate patient eligibility as necessary

• Assess and evaluate Medicaid claim payments utilizing company systems and payer payment documentation

• Investigate, request, and obtain medical records and supporting documentation for hospital claims

• Review and amend UB-04 billing components in compliance with billing regulations

• Follow up with payers via phone to confirm receipt of claims and facilitate reimbursement

• Prepare and submit initial Medicaid bill packets along with supporting documentation

• Analyze account delinquencies and activities to ensure timely and accurate payments

• Verify or request authorizations and assist with concurrent review processes

• Maintain confidential documentation and PHI in accordance with HIPAA guidelines

• Handle inbound and outbound calls

• Contribute to efficient workflow within the department as a team member

• Challenge claim denials and underpayments

• Execute additional duties as required

⛳️ Requirements

• High School Diploma or GED is mandatory

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

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

• At least 1 year of client-facing/customer service experience

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

• Experience with CMS-1500 billing and other complex claims is advantageous

• Intermediate knowledge of insurance payer/provider claims processing and data requirements

• Preferred intermediate understanding of Medicaid payers

• Equivalent combinations of education and experience will be taken into account

• Strong computer skills and proficiency in MS Office, including Word, Excel, and Outlook

• Consistent and reliable attendance

• Ability to meet or surpass productivity targets and objectives

• Capability to work independently without direct supervision

• Demonstrated written and verbal communication skills

• Strong analytical and problem-solving abilities

• Experience in working with external clients, showcasing strong customer service skills and business insight

• Ability to prioritize and manage multiple competing priorities and projects

• Capacity to remain stationary for 50% of the time

• Proficient in operating computers and office equipment

🏝️ Benefits

• Full-time employment

• Opportunities for professional growth and development

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

• Flexible and family-friendly work environment

• Support for work-life balance