revenue cycle specialist

Physician Care Coordination Consultants (PC3)

<div>Description:
<p><b>
Job Classification:</b></p><ul><li>This is an <i>exempt</i> position under the Fair Labor Standards Act (FLSA) and is not eligible for overtime pay.</li></ul><p><b>
Our Mission:</b></p><p>
Our mission is to drive financial wellness in healthcare organizations so more patients can receive the care they need.</p><p><b>
Our Vision:</b></p><p>
Our vision is a future where we help healthcare organizations thrive in a complex ecosystem by clearing a path to financial health.</p><p><b>
Our Culture:</b></p><p>
We are committed to creating a workplace where every member feels valued, empowered, and inspired to contribute their best. Together we will foster a culture that promotes work-life balance and celebrates community engagement, personal achievements, milestones, and special occasions.</p><p><b>
Values:</b></p><p><b>
Integrity </b><i>&ndash; </i>We do what&rsquo;s right, no matter what.</p><p><b>
Innovation </b><i>&ndash; </i>We use a harmonious blend of data, tech, and a human-centric approach.</p><p><b>
Compassion </b><i>&ndash; </i>We understand the stress of healthcare organizations and their patients.</p><p><b>
Determination </b>&ndash; Our mission is our guiding force.</p><p><b>
Partnership </b>&ndash; We build enduring relationships through listening, communication and accountability.</p><p><b>
Dignity </b>&ndash; We have significant pride in each other and our work.</p><p><b><br>
Job Summary:</b></p><p>
The Revenue Specialist will demonstrate behavior that supports PC3&rsquo;s mission, culture, and values. The successful candidate will play a crucial role in optimizing the financial health of the client by identifying and successfully resolving, recovering, and preventing potential loss of revenue due to claim payment issues. They must have experience in a healthcare environment and with the insurance and revenue cycle industry and be well versed in CPT medical codes and denial reason codes.</p><p>
The Revenue Specialist will take necessary follow-up actions, including appealing denied claims with appropriate documentation and justification, identify and correct billing issues related to denials and claim rejections, dispute underpayments, audits, recoupments, report trends, and actively participate in process improvement projects when necessary. The specialist&rsquo;s persistence helps recover revenue that might otherwise be lost due to claim denials. For this reason, the Revenue Specialist must stay informed about healthcare regulations, privacy laws, and insurance policies and ensure billing practices align with legal requirements and must adhere to compliance standards and regulations related to medical billing and coding.</p><p>
This position reports directly to the Director of Revenue Strategy.</p><p><b>
Supervisory Responsibilities:</b></p><p>
This position has no direct supervisory responsibilities.</p><p><b>
Duties/Responsibilities:</b></p><ul><li>
Manage denials, appeals, audits, and other revenue cycle functions.</li><li>
Review accounts pre-service for adherence to payor guidelines including but not limited to validating correct coding, reviewing payor policies, and obtaining prior authorization.</li><li>
Coordinating with insurance providers and resolving claim denials or discrepancies.</li><li>
Effectively communicating with patients and insurance companies is essential for successful collections.</li><li>
Work product and performance are required to meet quality standards established by PC3 partners.</li><li>
Analyze data and trends to identify opportunities for process improvement.</li><li>
Participate in process reviews and implementation for clients.</li><li>
Maintain confidentiality of patient information in accordance with HIPAA guidelines.</li><li>
Attend educational sessions including but not limited to webinars, online resources, in-person conferences, and other educational opportunities to stay up to date on revenue cycle functions as necessary.</li><li>
Other duties as assigned.</li></ul>
Requirements:
<p><b>
Knowledge/Skills/Abilities:</b></p><ul><li>
Knowledge of healthcare regulations, accreditation standards, and payer requirements.</li><li>
Strong computer skills and working knowledge of the Electronic Medical Records (EMRs).</li><li>
Requires communication skills to communicate clearly and concisely verbally and in writing with clients, peers, payers, physicians, and ancillary departments.</li><li>
Knowledge/experience utilizing the Epic software system and/or other billing platforms.</li><li>
Proficient in Microsoft Office applications.</li><li>
Strong interpersonal and organizational skills.</li></ul><p><b>
Education and Experience:</b></p><ul><li>
High school diploma</li><li>
LPN or RT preferred</li><li>
3 Years Revenue Cycle experience.</li><li>
Familiarity with the insurance industry.</li><li>
Applied knowledge of CPT, ICD &amp; DRG coding systems.</li></ul><p><b>
Physical Requirements:</b></p><ul><li>
Prolonged periods of sitting at a desk and working on a computer.</li><li>
Must be able to lift up to 15 pounds at times.</li></ul></div>

Revenue Cycle Specialist

Graham Regional Medical Center

<div>Description:
<p>
ORGANIZATIONAL DESCRIPTION</p><p>
The Revenue Cycle Specialist assists with various financial tasks, specifically payment and collections, for the hospital.
</p><p>INTERACTION</p><p>
Primarily Interacts with: administration, providers, employees, clinical and non-clinical departments, patients, and insurance companies.</p><p>
ESSENTIAL FUNCTIONS</p><ul><li>
Work with providers and patients as necessary for enrollment, patient financials, or eligibility and authorization.</li><li>
Obtain appropriate demographic and insurance/billing information from the patient and ensure accurate data entry.</li><li>
Verify patient eligibility and/or benefits; follow up with the patient and their health plan to determine if the patient is covered.</li><li>
Complete or obtain insurance verifications and obtain authorizations or referrals as required.</li><li>
Engage directly with patients to explain their bills, resolve billing inquiries, and collect payments or set up payment plans for outstanding balances, ensuring a positive customer service experience.</li><li>
Research any payment discrepancies.</li><li>
Work queues are in the appropriate module.</li><li>
Handle denials and appeals of claims.</li><li>
Post payments received and make financial adjustments as appropriate.</li><li>
Post in the General Ledger and Accounts Receivable system.</li><li>
Pull the explanation of benefits electronically and process accordingly.</li><li>
Pick up mail from the post office and process incoming mail daily.</li><li>
Uploads EMS mail into the Digitech FTP</li><li>
Scan all the supporting documentation.</li><li>
Upload correspondence and payments to Ditech daily.</li><li>
Maintain records for the financial department on a cash flow spreadsheet.</li><li>
Distribute payment receipts to the appropriate department managers.</li><li>
Prepare the bank deposit daily and take it to the bank.</li><li>
Send out the daily cash log.</li><li>
Create client invoices and send out the bills monthly.</li><li>
Process refunds.</li><li>
Balance petty cash daily.</li><li>
Pull bank deposit transactions daily from the banks.</li><li>
Upload reports daily to the appropriate FTP.</li><li>
Create reports as required.</li><li>
Process charity care applications.</li><li>
Run reports monthly and process them.</li><li>
Process worker compensation and MVA accounts.</li><li>
Process the payroll deduction report received from HR biweekly.</li><li>
Process and send billing records.</li><li>
Assist with special projects as assigned.</li><li>
Maintain the confidentiality of patient information in compliance with HIPAA.</li><li>
Provide exemplary customer service.</li><li>
Cooperate with other personnel to achieve departmental objectives and maintain good employee relations, inter-departmental objectives, and infection control policies.</li><li>
Cordially demonstrate timeliness and professionalism in appearance, communications, and actions during all interactions and with all individuals and entities.</li><li>
Solve practical problems, dealing with a variety of issues, and interpret a variety of instructions furnished in written and oral form.</li><li>
Attend meetings as required.</li><li>
Perform other duties as requested or assigned.</li></ul><p>
ABILITY TO USE EQUIPMENT, TOOLS, MATERIALS, MACHINES: Computer, telephone, facsimile machine, copier, scanner, printer, calculator, and other standard office equipment.</p>
Requirements:
<p>
EDUCATION/EXPERIENCE/SKILLS/ABILITIES</p><p>
Education:</p><ul><li>
Minimum High School diploma or GED required.</li><li>
College-level coursework in accounting or related field preferred.</li></ul><p>
Experience:</p><ul><li>
Two years of similar experience required in a healthcare setting.</li><li>
Experience with and understanding of medical and insurance terminology required.</li></ul><p>
Personal Job-Related Skills / Abilities:</p><ul><li>
Must be able to adapt quickly to changing situations.</li><li>
Ability to analyze information and make decisions using reasonable and logical judgment.</li><li>
Excellent command / highly proficient in spoken and written English; bilingual in Spanish preferred.</li><li>
Intermediate computer skills, including but not limited to: Microsoft Office &ndash; in particular Excel, electronic medical documentation, and email.</li><li>
Strong mathematical skills required.</li><li>
Must be able to adequately and quickly learn new software programs and serve as a Super User.</li><li>
Must be committed to quality and patient safety at all times.</li><li>
Must be able to communicate face-to-face and/or over the telephone.</li><li>
Must be able to work independently, and flexibly, and as a part of a multidisciplinary team.</li><li>
Must be able to manage several interruptions throughout the shift.</li><li>
Must have strong interpersonal and communication skills, verbal and written.</li><li>
Must have strong time management skills.</li><li>
Must be able to work under pressure while interacting in a helpful, courteous manner with a high degree of patient contact.</li><li>
Sufficient hearing, vision and dexterity to perform duties safely.</li></ul><p>
 Physical and Mental Requirements:</p><p>
Physical:
</p><ul><li>Activity Up to %: Walking 25; Squatting 10; Standing 25; Pulling 10; Kneeling 10; Reaching 35; Sitting 80; Lifting up to30 lbs 20; Pushing 10; Wrist/Finger Movements 90; Bending 25; Climbing 10
</li></ul><p>Mental:
</p><ul><li>Stress Level Moderate to High</li></ul><ul><li>
Individual position core competencies:</li><li>
Quality</li><li>
Service Excellence</li><li>
Compassion</li><li>
Professionalism</li><li>
Fiscal Responsibility</li></ul><p>
Required education within first 60 days (if employee is from outside organization).</p><ul><li>
GrahamRMC Orientation</li><li>
Department Orientation</li></ul><ul><li>
Continuing/Annual Education and Training:</li><li>
Falling Star Program</li><li>
Safety Storm Program</li></ul><p>
 5. Supervision</p><p>
Employees Supervised: __No__</p><p>
ADA REQUIREMENTS</p><p>
An &lsquo;X&rsquo; under the most appropriate category is marked and describes any extreme or hazardous working conditions that the job has to work under:</p><ul><li>
 Frequency of Condition</li></ul><p>
Condition 1-33% + Description</p><p>
Extreme Heat X
</p><p>Extreme Cold X
</p><p>Extreme Swings in Temperature X
</p><p>Extreme Noise X
</p><p>Working Outdoors X
</p><p>Mechanical Hazards X
</p><p>Electrical Hazards X
</p><p>Explosive Hazards X
</p><p>Fume/Odor Hazards X
</p><p>Dust/Mite Hazards X
</p><p>Chemical Hazards X
</p><p>Toxic Waste Hazards X
</p><p>Radiation Hazards X
</p><p>Wet Hazards X
</p><p>Heights X
</p><p>34-66% + Description</p><p>
-</p><p>
67%+ Description</p><p>
Working Indoors X</p><p>
OSHA Classification:</p><ul><li>
Identify with a check the OSHA Job Category that describes this job. The intent is to enhance worker protection by identifying any risk in the performance of routine and reasonably anticipated job-related functions.</li></ul><p>
__X__ Category III: Tasks that involve no exposure to blood, body fluids or tissues and Category I tasks are not a condition of employment.</p><p>
The normal work routine involves no exposure to blood, body fluids or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone and personal contacts such as handshaking are Category III tasks.</p></div>

SMP Health

<p></p><div><div><div><div><div><div><div><h2 class="jobSectionHeader"><b>WHAT YOU CAN EXPECT</b><b> FROM SMP HEALTH</b></h2></div></div><h6 class="jobSectionHeader"><b>
Below is a list of available benefits for those working 15 hours or more per week:</b></h6></div></div></div></div><div></div><div><div><div><div><div><div><div><div>
</div></div></div><div><h6 class="jobSectionHeader"><b>
HEALTH INSURANCE</b></h6></div></div><div><div><p>
Employees working 60 hours or more in a 2-week pay period are eligible for health insurance. Please see your Human Resources Specialist regarding plan benefits and enrollment criteria. We also offer Dental and Vision plans for eligible employees.</p></div></div></div></div></div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
HEALTH SAVINGS ACCOUNT (HSA)</b></h6></div></div><div><div><p>
SMP Health provides a high deductible health care plan with an HSA. Please see your Human Resources Specialist regarding plan benefits and enrollment criteria.</p></div></div></div></div></div></div><div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
FLEXIBLE SPENDING ACCOUNTS (FSA)</b></h6></div></div><div><div><p>
If you do not have an HSA, you might consider a Flexible Spending Account, which provides you with the opportunity through payroll deduction to set aside a portion of what would have been taxable income and deposit the money into a Personal Reimbursement Account to be used for medical expenses.</p></div></div></div></div></div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
RETIREMENT AND THE 401(K) SAVINGS PLAN</b></h6></div></div><div><div><p>
A 3% contribution is provided by the SMP Health at no cost to the employee. The 3% contribution is based on an employee&rsquo;s gross earnings after one year of service by the SMP facility. To meet eligibility requirements, employees must complete 1,000 hours of service within a 12-month period, and the employee must be 21 years of age.</p></div></div></div></div></div></div><div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
SHORT TERM DISABILITY PROGRAM</b></h6></div></div><div><div><p>
A serious medical condition can result in the loss of income that is important to you. The disability plans administered by SMP Health will help to provide protection during such an event.</p></div></div></div></div></div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
SERVICE AWARDS</b></h6></div></div><div><div><p>
In recognition of service to SMP Health, you will receive recognition after the following continuous years of service: 3, 5, 10, 15, 20, etc. Each milestone in your service at SMP Health System will be recognized by your facility.</p></div></div></div></div></div></div><div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
EMPLOYEE ASSISTANCE PROGRAM (EAP)</b></h6></div></div><div><div><p>
Through LiveWell Solutions (our Employee Assistance Program), SMP Health provides a valuable benefit to you and your family members by making available independent and objective counseling or referral for marital, family, legal, financial, emotional, and chemical dependency problems.</p></div></div></div></div></div><div><div><div><div><div><div><div>
</div></div></div><div><h6 class="jobSectionHeader"><b>
STUDENT LOAN REIMBURSEMENT</b></h6></div></div><div><p>
Eligible employees can receive up to $5,000 per year in student loan reimbursement for qualifying degrees, available after one year of continuous service.</p></div></div></div></div></div><div><div><div><div><div><div><div><div>
</div></div></div><div><h6 class="jobSectionHeader"><b>
ON-SITE CHILD DAYCARE</b></h6></div></div><div><div><p>
SMP Health &ndash; St. Catherine South has an onsite licensed child daycare available for employees&rsquo; children ages infant through Pre-K. SMP Health &ndash; St. Catherine South provides this service as a benefit for our employees at a reduced rate.</p></div></div></div></div></div><div><div><div><div><div><div><div><br>
</div></div></div><div><h6 class="jobSectionHeader"><b>
PAID TIME OFF (PTO) &amp; HOLIDAYS</b></h6></div></div><div><p>
Paid Time Off is provided to each employee in a benefit-eligible position of at least 15 hours per week. It is an account in which all earned credit for vacation, holidays, and short-term sick time accumulates. PTO is earned at a set ratio which increases with years of service.</p><p>
There are 7 holidays per year. Hourly employees will receive 1 &frac12; times their regular rate of pay for working on a paid holiday.</p></div></div></div></div></div></div><div></div>
<br><div><div>Senior Revenue Cycle Specialist </div><div>Full-time</div><div> 8:00am-4:30pm</div><div> $28+ per hour, with opportunities for higher compensation based on relevant experience.</div><div> The Senior Revenue Cycle Specialist is responsible for managing resident billing, collections, reimbursement, and accounts receivable functions in a long-term care setting. This role ensures accurate and timely billing for Medicare, Medicaid, private pay, VA, and other payer sources while maintaining compliance with applicable regulations. The Senior Revenue Cycle Specialist serves as a key liaison between the facility, residents, families, and external agencies to support financial operations, reimbursement, and customer service. This position requires strong analytical and problem-solving skills to effectively manage complex payer requirements, resident account issues, and reimbursement processes.</div></div>

Senior Revenue Cycle Specialist

Aspen Dental

<div><p>The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S. and has supported over 20,000 healthcare professionals and team members with close to 1,500 health and wellness offices across 48 states in four distinct categories: dental care, urgent care, medical aesthetics, and animal health. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Chapter Aesthetic Studio, and AZPetVet. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.
</p><p></p><p>As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as a Revenue Cycle Management Specialist.</p><p></p><p><b>
Essential Responsibilities</b></p><ul><li><p>
RCM Specialists care for the people who care for our patients by performing insurance adjudication, customer service, and patient collection job functions that require superior service and attention to detail.</p></li><li><p>
Bring better care to the front lines by supporting the execution and achievement of functional areas and company goals.</p></li><li><p>
Partners with internal departments to resolve issues related to all tasks and assignments supporting the business.</p></li><li><p>
Point of contact for internal and external customer inquiries, which entails contacting insurance companies and/or addressing patient inquiries.</p></li><li><p>
Uses software and company systems to source, obtain, process, audit and analyze standard data reporting and presenting.</p></li><li><p>
Plans, organizes, and executes tasks and activities with urgency and in accordance with managers&rsquo; delegated assignments.</p></li><li><p>
Responds to and resolves issues related to claim adjudication, patient and billing inquiries, while seeking managers guidance for non-routine inquiries or escalated concerns.</p></li><li><p>
May be required to meet position related productivity and quality standards.</p></li><li><p>
Other duties as assigned.</p></li></ul><p></p><p><b>
Requirements/Qualifications</b></p><ul><li><p>
Level: High School diploma or equivalent</p></li><li><p>
Job related/Industry experience preferred</p></li><li><p>
Excellent verbal and written communication skills</p></li><li><p>
Excellent organizational and time management skills</p></li><li><p>
Excellent problem solving/analysis collaboration</p></li><li><p>
Self-motivated individual with strong attention to detail</p></li><li><p>
Leadership experience preferred</p></li></ul><p></p><p>
A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match</p><p>
View CA Privacy Policy</p><p></p><p>
Hourly pay range: $19-22/hr</p></div>

Revenue Cycle Management Specialist

Boston Children's Hospital

<p></p><div><div><div><div>The Revenue Integrity Specialist supports Boston Children&rsquo;s Hospital&rsquo;s surgical and clinical practices by helping ensure accurate billing, appropriate charge capture, and strong compliance across the revenue cycle. This role focuses on identifying revenue opportunities, reducing denials, and minimizing financial and regulatory risk. The specialist works closely with clinical departments and the Revenue Integrity team to interpret billing rules, analyze data, and implement process improvements that strengthen revenue performance and compliance.<br>
<br>
Key Responsibilities<ul><li>
Analyze Epic revenue cycle and usage reports to identify billing errors, trends, and revenue opportunities</li><li>
Monitor and resolve work queue issues, correcting charge errors and ensuring timely resolution</li><li>
Review clinical department billing, coding, and charging workflows to ensure accurate revenue capture and compliance with payer and government regulations</li><li>
Analyze denial data to identify root causes and implement corrective action plans</li><li>
Provide education, guidance, and training to clinical departments on charge capture, coding, and billing best practices</li><li>
Support interpretation and implementation of billing and coding rule changes (government and payer updates)</li><li>
Develop and execute work plans to improve revenue cycle performance and reduce avoidable denials</li><li>
Partner with Revenue Integrity team members to use reporting tools and dashboards to monitor compliance and financial risk</li><li>
Assist in maintaining consistent charge capture practices and supporting ongoing compliance efforts across departments</li></ul><br>
Minimum Qualifications<ul><li>
Strong understanding of healthcare revenue cycle operations</li><li>
Ability to analyze billing, coding, and reimbursement data</li><li>
Experience working with managed care contracts and payer rules</li><li>
Knowledge of Medicare, Medicaid, and third-party billing guidelines</li><li>
Ability to identify root causes of billing errors and implement solutions</li><li>
Strong analytical, problem-solving, and critical thinking skills</li><li>
Ability to work collaboratively with clinical, financial, and operational teams</li><li>
Excellent written and verbal communication skills</li></ul><br>
Education<ul><li>
High School Diploma or GED required</li><li>
Bachelor&rsquo;s Degree preferred</li></ul><br>
Experience<ul><li>
Minimum of 1 year of experience in a hospital or healthcare billing environment required</li><li>
Experience with revenue cycle, charge capture, denial management, or coding preferred</li></ul><br>
Schedule<br>
Full time- remote<br>
<br>
Boston Children&rsquo;s Hospital Benefits<br>
Boston Children&rsquo;s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings Plan, Pension, tuition and certain license and certification reimbursement, cell phone plan discounts, and discounted T-passes. Experience the benefits of passion and teamwork.</div><br>
</div><div><p><b>Status</b></p>
<div>Full-Time</div>
</div><div><p><b>Regular, Temporary, Per Diem</b></p>
<div>Regular
</div></div><div><p><b>Standard Hours per Week</b></p>
<div>40
</div></div><div><p><b>Pay Range</b></p>
<div>$58676.80-$93901.60 Annual</div>
</div><div><p><b>Office/Site Location</b></p>
<div>Boston</div>
</div><div><p><b>Job Posting Category</b></p>
<div>Administration</div>
</div><div><p><b>Remote Eligibility
</b></p><div>Full-Time Remote</div></div></div></div><div></div>

Revenue Integrity Specialist- Remote

Carolina Oncology Specialists

<div><p>Carolina Oncology Specialists has been caring for patients in Catawba County since 1983, offering patients high quality, personalized healthcare close to their own home so patients and caregivers don&rsquo;t have to travel far for excellent care. Our patients experience the convenience of in-clinic chemotherapy treatments, as well as the treatment and management of blood disorders.</p><p></p><p>
Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.</p><p></p><p><b>
Job Description:</b></p><div><div><p><b>
 </b>Job Description: Reconciliation Specialist</p></div><div><p><b>
 </b><b>Organization:</b> Carolina Oncology Specialists<br>
<b>Location:</b> Remote-Charlotte, NC<br>
<b>Department:</b> Revenue Cycle Management<br>
<b>Reports To:</b> RCM Manager</p></div><p></p><div><p><b><br>
Position Summary</b></p></div><div><p>
The Reconciliation Specialist is responsible for ensuring the accuracy and integrity of financial transactions related to patient accounts, insurance payments, and practice revenue. This role plays a critical part in maintaining financial compliance by reconciling payments, identifying discrepancies, and supporting revenue cycle optimization efforts within Carolina Oncology Specialists.</p></div><p></p><div><p><b><br>
Key Responsibilities</b></p></div><div><ul><li><p>
Perform daily, weekly, and monthly reconciliation of payments, including insurance remittances, patient payments, and electronic funds transfers (EFTs).</p></li></ul></div><div><ul><li><p>
Compare bank deposits, clearinghouse reports, and practice management system data to ensure alignment and completeness.</p></li></ul></div><div><ul><li><p>
Investigate and resolve discrepancies, including underpayments, overpayments, and unapplied cash.</p></li></ul></div><div><ul><li><p>
Work closely with billing, coding, and collections teams to correct posting errors and ensure accurate account balances.</p></li></ul></div><div><ul><li><p>
Monitor and reconcile accounts receivable transactions to support clean financial reporting.</p></li></ul></div><div><ul><li><p>
Validate contractual adjustments and payer reimbursement accuracy.</p></li></ul></div><div><ul><li><p>
Ensure timely posting and reconciliation of all revenue streams.</p></li></ul></div><div><ul><li><p>
Maintain detailed records of reconciliation activities and audit trails.</p></li></ul></div><div><ul><li><p>
Prepare and distribute reconciliation reports to leadership, highlighting trends and issues.</p></li></ul></div><div><ul><li><p>
Support internal and external audits by providing documentation and analysis.</p></li></ul></div><div><ul><li><p>
Assist in process improvement initiatives to strengthen revenue cycle efficiency and reduce errors.</p></li></ul></div><p></p><div><p><b><br>
Required Qualifications</b></p></div></div><div><div><ul><li><p>
High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in Accounting, Finance, or related field preferred.</p></li></ul></div><div><ul><li><p>
Minimum of 2&ndash;4 years of experience in healthcare finance, medical billing, or revenue cycle reconciliation.</p></li></ul></div><div><ul><li><p>
Strong understanding of insurance remittances (EOBs/ERAs), payment posting, and healthcare reimbursement processes.</p></li></ul></div><div><ul><li><p>
Proficiency in practice management systems and Microsoft Excel (including pivot tables and reconciliation functions).</p></li></ul></div><div><ul><li><p>
High level of attention to detail and accuracy.</p></li></ul></div><div><ul><li><p>
Strong analytical and problem-solving skills.</p></li></ul></div><div><ul><li><p>
Ability to manage multiple priorities and meet deadlines.</p></li></ul></div><p></p><div><p><b><br>
Preferred Qualifications</b></p></div><div><ul><li><p>
Experience in oncology or specialty medical practice.</p></li></ul></div><div><ul><li><p>
Familiarity with payer contracts and reimbursement methodologies.</p></li></ul></div><div><ul><li><p>
Knowledge of regulatory guidelines related to healthcare billing and compliance.</p></li></ul></div><p></p><div><p><b><br>
Key Competencies</b></p></div><div><ul><li><p>
Financial Accuracy &amp; Integrity</p></li></ul></div><div><ul><li><p>
Analytical Thinking</p></li></ul></div><div><ul><li><p>
Problem Resolution</p></li></ul></div><div><ul><li><p>
Attention to Detail</p></li></ul></div><div><ul><li><p>
Collaboration &amp; Communication</p></li></ul></div><div><ul><li><p>
Time Management</p></li></ul></div></div><p></p><div><div><p><b><br>
Working Conditions</b></p></div><div><ul><li><p>
Primarily office-based role with extended periods of computer work.</p></li></ul></div><div><ul><li><p>
May require occasional extended hours during month-end close or audit periods.</p></li></ul></div></div></div>

Reconciliation Specialist

HealthRev Partners

<div><p><b>Job Summary:</b></p><p></p><p><br>
The <b>RCM Specialist for Home Health &amp; Hospice</b> plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues.</p><br>
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<p><b>
Essential Duties and Responsibilities:</b></p>
<ul>
<li>Lead and optimize the full revenue cycle process from billing the claim to final payment collection.</li>
<li>Collaborate with the RCM team to maintain a clean and compliant revenue cycle.</li>
<li>Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol.</li>
<li>Resubmit claims corrected as needed and communicate issues that need to be resolved.</li>
<li>Communicate unbilled and billed claim holds to Team Leader or RCM Manager.</li>
<li>Analyze and resolve complex claims denials and appeals.</li>
<li>Investigate and address patient billing discrepancies and disputes.</li>
<li>Identify and implement strategies to improve revenue cycle performance as needed.</li>
<li>Collaborate with cross-functional teams to implement and manage assigned RCM accounts.</li>
<li>Participate in revenue cycle audits and compliance reviews (quality review checks).</li>
<li>Develop and maintain accurate and up-to-date documentation of all claims and patient accounts.</li>
<li>Provide training and support to other RCM team members.</li></ul><br>
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<p><b>
Key Performance Indicators (KPIs):</b></p>
<ul>
<li>Clean claim rate &gt;95%</li>
<li>Aged AR &lt; 20% of total AR</li>
<li>Meets productivity expectation of 45 non-Medicare claims per day or 75 Medicare</li>
<li>Net collection rate of &gt;95%</li>
<li>Meets and passes 100% of quality review checks completed by RCM Manager</li></ul><br>
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<p><b>
Qualifications:</b></p>
<ul>
<li>3&ndash;5 years of experience in revenue cycle management in the home health and hospice realm</li>
<li>Proficient in Microsoft Office Suite 365</li>
<li>Proficient in home health and hospice electronic health records (EHR) systems</li>
<li>Strong understanding of insurance billing and coding procedures</li>
<li>Excellent communication, problem-solving, and analytical skills</li>
<li>Ability to work independently and as part of a team</li>
<li>Proven track record of success in resolving complex claims and patient billing issues</li></ul><br>
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<p><b>
Benefits:</b></p>
<ul>
<li>Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, paid time off, and 401k savings plan</li>
<li>Opportunity to work in a dynamic and growing healthcare organization</li>
<li>Professional development and training opportunities</li>
<li>Contribution to the organization's financial success and patient satisfaction</li></ul></div>

RCM Specialist- Home Health and Hospice

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RCM Specialist- Home Health and Hospice