Senior Revenue Cycle Specialist

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

📋 Description

• Submit and resolve medical claims for both inpatient and outpatient settings with moderate to high complexity.

• Stay updated on billing, follow-up, and appeal requirements set by governmental bodies and third-party payers.

• Manage specialty billing claims, address escalated accounts receivable issues, and participate in health-system special projects.

• Provide responses to inquiries from management, staff, physicians, patients, and insurance representatives.

• Uphold confidentiality and professionalism regarding patient and physician information.

• Adhere to departmental policies and procedures to ensure timely and accurate resolution of claims.

• Communicate effectively via telephone, written correspondence, email, and internal channels to address inquiries and insurance matters.

• Attend and engage in team meetings.

• Analyze account balances using work lists to facilitate payment collection for medical services.

• Review and update billing information for patients across various system applications.

• Collaborate with both internal and external customers to resolve claims and receivables in a high-volume setting.

• Follow up with insurance companies to ensure appropriate payment of claims.

• Address denials, correct claims, and initiate appeals as necessary.

• Contact patients and guarantors to gather essential billing information.

• Document accounts clearly and concisely in accordance with departmental procedures.

• Review and respond to written correspondence and inquiries.

• Act as a subject matter expert and primary resource for junior staff members.

• Conduct training sessions and develop process documentation.

• Assist management with special projects as needed.

• Lead workflow initiatives in the absence of management.

• Participate in or facilitate payer and departmental meetings.

• Provide management with feedback and suggestions for process improvements.

• Achieve and surpass team productivity and quality benchmarks.

• Independently analyze and resolve claims issues.

• Create Excel spreadsheets to assist in claim analysis and resolution.

• Perform additional duties as assigned.

• Comply with all established policies and standards.

• Safely and securely manage Protected Health Information (PHI).

⛳️ Requirements

• High School Equivalent / GED (Required)

• Associate's Degree (Preferred)

• Bachelor's Degree (Preferred)

• A minimum of 3 years of experience in medical billing/claims (Required)

• Proficiency with medical billing software (Required)

• Strong understanding of claim submission processes using UB04/HCFA 1500 and various third-party payers.

• Knowledge of procedural and ICD10 coding.

• Familiarity with medical billing terminology.

• Detail-oriented, organized, and possess strong analytical and problem-solving skills.

• Excellent client service, communication, and relationship-building abilities.

• Capability to work independently as well as collaboratively within a team in a fast-paced environment.

• Strong verbal and written communication skills.

• Proficient in using PCs, Microsoft Office suite including Word, Excel, and Outlook, along with general office equipment.

• Ability to securely handle Protected Health Information (PHI).

• Capability to meet physical demands including occasional standing, walking, handling, and grasping; constant sitting, talking, and hearing; frequent repetitive motions and hand-eye coordination.

• Willingness to travel as required; travel expectations are approximately 10%.

🏝️ Benefits

• Full-time work schedule.

• Regular employee status.

• Day shift availability.

• Option for remote work.

• Annual training opportunities.

• Adherence to the UH Code of Conduct and workplace policies and procedures.

• Travel requirement listed as 10%.