revenue cycle specialist

Clearwave Mental Health

<p><b>Company Overview</b><br/>Clearwave Mental Health is dedicated to providing compassionate, personalized, and innovative mental health treatment to our community. Led by experienced medical professionals, we are committed to advancing mental health care through cutting-edge therapies and comprehensive services.</p><p><b>Job Summary</b><br/>We are seeking a motivated and detail-oriented Revenue Cycle Specialist to join our dynamic team. In this vital role, you will manage the full revenue cycle, from insurance verification and claims submission through payment posting, denials management, and patient billing support. This is an in-person, full-time role in Poughkeepsie, NY.</p><p><b>Responsibilities</b></p><ul><li>Manage the end-to-end revenue cycle: verify insurance coverage, submit claims, track status, resolve denials, and follow up for payment.</li><li>Process insurance claims accurately and efficiently through our billing system.</li><li>Post insurance payments, reconcile accounts, and monitor outstanding balances.</li><li>Contact insurance companies to resolve claim issues, including managed Medicaid plans, prior authorizations, and behavioral health claim nuances.</li><li>Collaborate with providers and front office teams to support specialized services, such as TMS and Spravato treatments.</li><li>Communicate professionally with patients regarding balances and billing questions.</li><li>Ensure all patient information is secure and that all communications and disclosures are HIPAA compliant.</li><li>Perform any other tasks or responsibilities as needed and communicated by the Executive Team.</li></ul><p><b>Requirements</b></p><ul><li>Proven experience in medical billing, coding, or revenue cycle management within a healthcare setting.</li><li>Demonstrated experience with complex denials, appeals, and payer follow-up.</li><li>Familiarity with major commercial payers (BCBS, United Healthcare, Aetna, etc.) and Medicaid/Medicare plans.</li><li>Proficiency with EHR/EMR systems and billing platforms.</li><li>Knowledge of CPT/HCPCS and ICD-10 coding standards.</li><li>Strong communication skills for interacting with patients, providers, and insurance representatives.</li><li>Detail-oriented, organized, and able to manage multiple claims efficiently.</li><li>Prior experience in mental health or behavioral health settings is a plus.</li></ul><p><b>Preferred: </b></p><ul><li>Associate or bachelor&rsquo;s degree in health administration, accounting, or related field.</li><li>Hands-on medical billing/claims management experience, preferably in mental health or outpatient care.</li></ul><p>Join us as a Revenue Cycle Specialist and be a key player in delivering quality mental health services while ensuring our financial operations run smoothly!</p><p>Pay: From $23.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li></ul><p>Work Location: In person</p>

Revenue Cycle Specialist

Maryville, Inc

<p><b>Job Title: Revenue Cycle Specialist</b></p><p><b>Location:</b> South New Jersey<br/><b>Department:</b> Finance / Revenue Cycle<br/><b>Reports To:</b> CFO<br/><b>FLSA Status:</b> Exempt</p><p><b>Position Summary</b></p><p>The Revenue Cycle Specialist is responsible for supporting the full revenue cycle process for a nonprofit behavioral health organization, including client billing, claims submission, payment posting, and follow-up on outstanding accounts. This role ensures timely and accurate reimbursement from Medicaid, Medicare, and commercial payers while maintaining compliance with federal, state, and payer-specific regulations.</p><p>In addition, this position supports EMR system maintenance related to billing functions and plays a key role in identifying revenue cycle issues, conducting root cause analysis, and contributing to process improvements that enhance overall financial performance.</p><p><b>Key Responsibilities</b></p><p><b>Billing &amp; Claims Management</b></p><ul><li>Prepare and submit accurate claims to Medicaid, Medicare, and commercial insurance payers</li><li>Verify client insurance eligibility and benefits prior to service billing</li><li>Review documentation to ensure billing compliance with payer requirements</li><li>Correct and resubmit denied or rejected claims in a timely manner</li></ul><p><b>Accounts Receivable &amp; Collections</b></p><ul><li>Monitor accounts receivable and follow up on unpaid or underpaid claims</li><li>Work claim denials and underpayments, identifying trends and recurring issues</li><li>Communicate with payers regarding claim status and reimbursement issues</li><li>Maintain AR aging within organizational benchmarks</li></ul><p><b>Payment Posting &amp; Reconciliation</b></p><ul><li>Post insurance and client payments accurately and timely</li><li>Reconcile daily deposits and payment reports</li><li>Identify discrepancies and resolve payment issues</li></ul><p><b>EMR System Support &amp; Maintenance (Revenue Cycle Focus)</b></p><ul><li>Maintain accurate client demographic, insurance, and billing information within the EMR system</li><li>Perform routine audits of EMR data to ensure billing accuracy and compliance</li><li>Identify and correct data entry errors that impact claims submission and reimbursement</li><li>Assist with system updates, billing configuration changes, and payer setup as needed</li><li>Collaborate with IT or EMR vendors to troubleshoot billing-related system issues</li><li>Support staff with EMR billing workflows and best practices</li></ul><p><b>Root Cause Analysis &amp; Process Improvement</b></p><ul><li>Analyze claim denials, payment delays, and billing errors to determine root causes</li><li>Track and report trends in denials, rejections, and accounts receivable performance</li><li>Recommend and implement corrective actions to prevent recurring issues</li><li>Collaborate with clinical, intake, and administrative teams to improve documentation and workflow processes</li><li>Assist in developing and updating revenue cycle policies and standard operating procedures</li><li>Support continuous quality improvement initiatives to enhance efficiency, accuracy, and reimbursement rates</li></ul><p><b>Compliance &amp; Documentation</b></p><ul><li>Ensure compliance with Medicaid, Medicare, and State of New Jersey billing regulations</li><li>Maintain accurate and complete billing records</li><li>Support internal and external audits as needed</li></ul><p><b>Collaboration</b></p><ul><li>Work closely with clinical, intake/admissions, and finance teams to resolve billing issues</li><li>Educate staff on documentation requirements impacting reimbursement</li><li>Support organization-wide initiatives to strengthen revenue cycle performance</li></ul><p><b>Qualifications</b></p><p><b>Education &amp; Experience</b></p><ul><li>Bachelor&rsquo;s degree preferred (Healthcare Administration, Business, or related field)</li><li>5+ years of experience in healthcare billing, preferably in behavioral health or substance use treatment</li><li>Experience with Medicaid billing in New Jersey strongly preferred</li></ul><p><b>Knowledge, Skills &amp; Abilities</b></p><ul><li>Strong understanding of revenue cycle processes (billing, AR, collections)</li><li>Experience working within EMR/EHR systems (behavioral health platforms preferred)</li><li>Ability to analyze data, identify trends, and recommend process improvements</li><li>Knowledge of CPT, HCPCS, and ICD-10 coding basics</li><li>Attention to detail and strong organizational skills</li><li>Ability to manage multiple priorities and meet deadlines</li><li>Strong communication and problem-solving skills</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience working in a nonprofit or community-based healthcare setting</li><li>Knowledge of New Jersey Medicaid (NJ FamilyCare) billing requirements</li><li>Experience with EMR systems such as Smart Care, Kipu</li><li>Certification such as Certified Billing and Coding Specialist (CBCS) or similar</li></ul><p><b>Work Environment</b></p><ul><li>Office-based or hybrid work environment</li><li>May require occasional overtime to meet billing deadlines</li></ul><p>Pay: $57,500.00 - $70,000.00 per year</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Employee discount</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Professional development assistance</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul><p>Application Question(s):</p><ul><li>Revenue Cycle experience required greater than 3 years</li><li>EMR implementation experience greater than 3 years</li></ul><p>Ability to Commute:</p><ul><li>Voorhees, NJ 08043 (Preferred)</li></ul><p>Work Location: Hybrid remote in Voorhees, NJ 08043</p>

Tamarack Health

<p></p><div><p><b>Job Overview:</b></p>
<p>
The Revenue Cycle Specialist is responsible for responding to and resolving a variety of account, billing and payment issues from patients and insurance companies. Reviews the medical record and abstracted information as necessary to provide insurance claim information or to resolve incoming correspondence regarding patient services. Reviews accounts to determine correct adjustments have been applied, payments posted and refunds distributed. Uses excellent customer service and interpersonal skills when interacting with patients and insurance companies, following confidentiality guidelines. Makes appropriate decisions that require individual and/or team analysis &ndash; utilizing good problem-solving skills. Interprets, applies and communicates federal regulations, insurance contracts and hospital-wide policies regarding the medical and financial aspects of patient care to ensure optimal third-party payment for the patient and the hospital.</p><br>
<p></p>
<p><b>
Responsibilities/Duties:</b></p>
<ul>
<li>Process complete and accurate claims in a timely and efficient manner, assuring that the payer guidelines are followed, facilitating compliance and maximum reimbursement.</li>
<li>Resolve system billing and claim WQ edits by working closely with Clinical departments, coding staff, and registration to assure errors are completed correctly and in a timely manner.</li>
<li>Takes a team approach to communicating insurance updates/changes to other specialists as well as external departments to assure compliance with all changes.</li>
<li>Utilize follow-up/denial WQ and Aging reports to ensure all unprocessed claims and denials are followed up on in a timely manner. Utilize problem-solving/root cause analysis to help identify possible solutions and work closely with your manager to update systems as needed.</li>
<li>Accurately submit claim appeals to support our charges and the reason for appealing.</li>
<li>Utilize system tools and available department resources to achieve efficiency and timely resolution of patient accounts. Consistent use of online payer resources.</li>
<li>Investigates and responds to insurance correspondence, questions, and/or requests for additional information in a timely and professional manner to ensure proper, timely, and accurate payment of patient accounts.</li>
<li>Review and process insurance and patient overpayment. Identify large insurance adjustments and review the contract to identify underpayments.</li>
<li>Serves as backup customer service. Accepting patient payments and setting up payment plans.</li>
<li>Performs other duties as required.</li>
<li>Adheres to STAR Standards policy.</li>
</ul>
<p><b>Education/Experience:</b></p>
<ul>
<li>High School diploma or equivalent preferred</li>
<li>One-year experience in healthcare, with knowledge of medical terminology preferred.</li>
<li>AAHAM certified Revenue Cycle Specialist (CRCS) preferred.</li></ul></div>

ArchWell Health

<b>Job Summary:</b><br>
The Revenue Cycle Specialist provides support of all aspects of Revenue Cycle Services and is responsible for supporting the efficiency and effectiveness of revenue cycle operations including vendor and MA plan partner collaboration to meet service level agreements and key performance indicators. The Revenue Cycle Specialist will assist in developing new and emerging approaches for our business processes, projects, and initiatives which will include deliverables that drive financial profitability and meet or exceed margin thresholds. This position reports to the Revenue Cycle Director and will be responsible for supporting the day-to-day revenue cycle operations. This role will collaborate with our clinical, operations and IT teams to drive results.
<br><br>
<b>Duties/Responsibilities:</b><br>
<ul>
<li>Support rapidly growing outsourced billing and coding teams, and identify ideal operating process flows as needed for scalability and optimization</li>
<li>Assist in developing strong internal processes and documented workflows in support of the revenue cycle, and ensure appropriate integration with field operations</li>
<li>Continually seek ways to improve the delivery and support of revenue cycle activities and provide recommendations for changes to proactively identify process improvement and eliminate barriers to success</li>
<li>Provide eligibility and insurance verification support to centers</li>
<li>Investigate and resolve issues related to patient coverage, effective dates, and missing enrollment information by contacting insurance companies, patients, and other departments. Maintain accurate patient demographic and insurance data in EHR</li>
<li>Confirm member co-pays, deductibles, coinsurance are accurately captured and collected</li>
<li>Support all aspects of coding and billing to ensure legal and compliance standards</li>
<li>Conduct internal audits of billing and coding practices. Provide regular cadence reporting to compliance.</li>
<li>Ensure adherence to CMS and payer specific regulations</li>
<li>Assist in building strong relationships with key stakeholders including finance and accounting, IT and field clinical operations.</li>
<li>Assist in the development of training materials and deliver in person training as needed to our field personnel as we open new centers</li>
<li>Occasional travel will be required (5-10%)</li>
</ul>
<b>Required Skills/Abilities:</b><br>
<ul>
<li>Deep understanding of revenue cycle functions and requirements in a complex, multi-state setting</li>
<li>Possess excellent communication skills, both written and oral</li>
<li>Proven performance results, decision making and judgement</li>
<li>Experience with external vendors and outsourced billing staff</li>
<li>Extensive knowledge of eClinicalWorks strongly preferred</li>
</ul>
<b>Education and Experience:</b><br>
<ul>
<li>Associate’s degree required</li>
<li>3+ years of revenue cycle experience in physician office setting</li>
<li>Coding certification (CPC, COC, CCS, CCA, CPB, CBCS) required or completed within 6 months of hire</li>
<li>Experience with capitated reimbursement models strongly preferred</li>
<li>Embodies and serves as a role model of ArchWell Health’s Values:</li>
<li>Be compassionate</li>
<li>Strive for excellence</li>
<li>Earn trust</li>
<li>Show respect</li>
<li>Stay resilient</li>
<li>Always do the right thing</li>
</ul>
<b>About ArchWell Health:</b><br>
At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.
<br>Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.
<br><br>
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
<br><br>
<b>Last Updated:</b> November 2025

Finance - Revenue Cycle Specialist

Oregon Health & Science University

<div>Department Overview:
<p>
The Centralized Check-In department is responsible for signing-in/admitting patients for their procedures and/or appointments at the Center for Health and Healing, Beaverton and Orenco campuses, as well as any new locations identified across OHSU Health in the future. If the patient has multiple procedures/appointments for that day, on a given campus, the Centralized Check-In process will allow the department to check-in/admit the patient for all care at one time.</p><p></p><p><br>
The Centralized Check-In department is also responsible for kicking off patients, event tracking, and signaling so that all care teams within the campus know where the patient is at in their care. Prior to signing-in/admitting a patient, the Centralized Check-In department is responsible for helping to resolve any critical properly prepared patient items that have not been completed (i.e. patient demographic and insurance/registration verification). Lastly, the Centralized Check-In department is responsible for greeting patients on specified floors within the campus to ensure patients are in the right place for their initial/next episode of care.</p>
Function/Duties of Position:
<div><b>
Customer Service</b></div><ul><li>
Provides high quality customer service to both external and internal customers that meets or exceeds the service standards of the health care industry.</li><li>
Promptly greet all patients, visitors, and others in a warm, courteous, and professional manner.</li><li>
Demonstrates the ability to communicate effectively, timely, and respectfully at all times, especially in a high stress environment.</li><li>
Provides flexible coverage to assist with internal service needs and the continuous application of process improvement methods and skills.</li><li>
Determines customer needs proactively, and direct inquiries to appropriate resources.</li><li>
As problems and miscommunications occur with internal or external customers, demonstrates the ability to clarify and resolve problems immediately to avoid further communication breakdowns.</li><li>
Demonstrates respect and cooperation in all staff relationships, with a genuine willingness to prevent or resolve inter-personal conflicts.</li><li>
Answers multi-line telephone inquiries. Determine caller needs and assist callers efficiently and appropriately.</li></ul><div><b>
Patient Registration/Interviews</b></div><ul><li>
Gathers, adds, updates, and/or verifies detailed demographic information and any applicable forms. Complete registration from patient work queues, email, or inbasket as assigned.</li><li>
Completes Race, Ethnicity, Language, and Disability (REALD) questionnaire with patient and updates REALD Smart Form as required by law. Serves as liaison for patients and families with questions.</li><li>
Satisfies state regulations to identify support persons for individuals with disabilities.</li><li><div>
Correctly identifies patient service type to establish an accurate and billable account.</div></li><li><div>
Corrects patient identity inaccuracies, as identified.</div></li><li><div>
Schedules reservations into Epic with a base knowledge of diagnoses and procedures.</div></li><li><div>
Validates appropriate admitting locations by procedure and admitting provider to ensure appropriate patient placement.</div></li><li><div>
Obtains signatures and enters into computer all facility and regulatory required data and forms. Reviews all for accuracy.</div></li><li><div>
Responsible for all identity management corrections after hours.</div></li><li><div>
Identifies and collects co-pays, deductible payments, deposits, and prepayments for services as required.</div></li></ul><div><b>
Insurance Verification/Financial Clearance</b></div><ul><li>
Gathers, adds, updates, and/or verifies detailed insurance coverage and financial status with each patient.</li><li>
Creates new and maintains existing insurance coverages/guarantors for a patient based on their insurances and the care being provided.</li><li>
Complete insurance verification on each patient&rsquo;s insurance using electronic verification in RTE, payer portals, or other required methods. The PAS Revenue Cycle Specialist staff will also re-verify the eligibility insurance information if the insurance was not verified in the current month.</li><li>
Reviews MMIS for all uninsured or single coverage patients.</li><li><div>
Refers all non-sponsored patients to Oregon Health Plan (OHP) and provides information for financial assistance, working closely with Financial and Medicaid Services.</div></li><li><div>
Ensures all required forms are completed for services and confirmation of payment sources.</div></li><li>
Maintains current information on managed care insurance plans and serves as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Applies problem solving and negotiating skills in resolving patient concerns and managed care related issues.</li></ul><div>
Other duties as assigned.</div>
Required Qualifications:
<ul><li><div>
High School diploma or equivalent; <b>AND</b></div></li><li><div>
One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and registration and/or billing responsibilities. <b>OR</b></div></li><li><div>
Two years of work experience in a high-volume direct public contact, front-line non-healthcare setting position.</div></li></ul><p><b>
Knowledge and Skills Required</b></p><ul><li>
Basic computer skills including word processing and Windows applications.</li><li>
Basic computer keyboarding skills including typing of minimum 40 wpm.</li><li>
Demonstrated working knowledge around insurances and benefits.</li><li>
Demonstrated excellent verbal and written communications skills.</li><li>
Strong customer service orientation.</li><li>
Demonstrated effectiveness during extremely confrontational customer interactions in a high stress environment.</li><li>
Demonstrated advanced PAS user skills or equivalent as well as extensive knowledge of integrated care models.</li><li><div>
Ability to walk and stand for 6-8hours a day, position is extremely mobile.</div></li><li><div>
Must be detail oriented, highly accurate and able to multi-task in high volume situations.</div></li><li><div>
Must have demonstrable record of reliable attendance, punctuality, and proven successful performance at past and present.</div></li></ul>
Preferred Qualifications:
<ul><li><div>Prior experience in medical office front desk and high patient volume.</div></li><li><div>
Experience with Epic.</div></li><li><div>
Knowledge and experience in Microsoft OneNote.</div></li><li><div>
Knowledge of PAS procedures and integrated care at OHSU preferred, and/or completion of a PAS Trainee program.</div></li><li><div>
Knowledge of Epic systems.</div></li><li><div>
Knowledge of OHSU network systems, including Outlook and Microsoft Office products.</div></li><li><div>
Knowledge of scheduling and front desk.</div></li><li><div>
Basic medical terminology.</div></li></ul>
Additional Details:
<div>Schedule: Monday - Sunday (variable), 5:00am - 8:00pm (variable).</div><div>
Locations are variable: Beaverton Clinics, Center for Health and Healing 1, Center for Health and Healing 2, and any other builds that have Centralized Check-In.</div><div>
</div><div><b>
Benefits</b></div><ul><li>
Healthcare for full-time employees covered 100% and 88% for dependents.</li><li>
$50K of term life insurance provided at no cost to the employee.</li><li>
Two separate above market pension plans to choose from.</li><li>
Vacation - up to 200 hours per year dependent on length of service.</li><li>
Sick Leave - up to 96 hours per year.</li><li>
9 paid holidays per year.</li><li>
Substantial Tri-Met and C-Tran discounts.</li><li>
Employee Assistance Program.</li><li>
Childcare service discounts.</li><li>
Tuition reimbursement.</li><li>
Employee discounts to local and major businesses.</li></ul>
Why apply to OHSU?: <b>We are Oregon's only public academic health center.</b> In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. <b>All are welcome.</b> OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu</div>

PAS Revenue Cycle Specialist

Senior Psych Care

<div><p><b>Senior PsychCare</b> has an immediate opportunity for a<b> Revenue Cycle Specialist II </b>to support our Billing Team in Houston.</p><p><b>
ABOUT US:</b></p><p>
Senior Psych Care provides fully integrative behavioral health services to the long-term care patient, at their facility. Services include individual, family, and group therapies, along with diagnostic evaluation and collaborative intervention between the therapy team and the psychiatric team.</p><p><b>
Job Description</b></p><p><b>
Revenue Cycle Specialist II</b> is responsible for processing follow-up actions on claims denied for eligibility-related reasons and responding to health plan correspondence. In this role, you would identify billing issues affecting the provider&rsquo;s claims and take necessary action to ensure timely and appropriate claim filing. In addition, perform follow-up activities and identifies reimbursement issues affecting these claims. The Revenue Cycle Specialist also takes necessary actions to insure accurate reimbursement and account resolution.</p><p><b>
Responsibilities :</b></p><ul><li>
Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher per day to ensure claim(s) resolution.</li><li>
Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD&rsquo;s) for claim resolution.</li><li>
Review and attach appropriate documentation to resolve denied claims and submit appeals.</li><li>
Call payers to determine the true reason for denial and inquire on what corrections need to be made.</li><li>
Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or payer portals.</li><li>
Review underpayments and overpayments, work with management to prepare spreadsheet and summarize findings; escalate as appropriate.</li><li>
Prepare and submit denied claims targeted project files to payers, track reprocessing of project files.</li><li>
Identify problematic claim trends and contract violations and report findings to the Manager and Director.</li><li>
Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.</li><li>
Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.</li><li>
Perform other duties assigned by Revenue Cycle Manger.</li></ul><p><b><i>
This is a full-time, in-person opportunity. Our work week is from Monday-Friday 8am-5pm (NO WEEKENDS Required).</i></b></p><p><b>
Qualifications-Required Experience: 3+ years of recent Healthcare experience, specifically in a claims, Denials, billing, EOB and insurance verification.</b></p><ul><li><b>
Minimum 1+ years&rsquo; experience in Government Payor follow- up (Required)</b></li><li><b>
Ability to work independently and prioritize monthly workflow (Required)</b></li><li><b>
Knowledge of Medical Terminology, CPT Codes, HCPCS, Revenue Codes, Modifiers and Diagnosis Codes (Required)</b></li><li><b>
Payer portal and clearinghouse experience (Required)</b></li><li><b>
Ability to work independently and prioritize monthly workflow (Required)</b></li><li><b>
Mental Health experience (Preferred)</b></li></ul><p><b>
What we offer:</b></p><ul><li>
Paid Time Off and Paid Holidays</li><li>
Comprehensive benefits packages including Medical, Dental, Vision, 401k, Long Term and Short-Term Disability, Life Insurance</li><li>
Healthcare coverage available 1st day of the month following full-time employment.</li></ul><p><b><i><br>
All interested candidates are encouraged to apply. Apply today and START NEXT WEEK!!!</i></b></p></div>

Revenue Cycle Specialist II – Appeals and Denials

Growth Ortho

<div><p><b>Revenue Cycle Reimbursement Specialist</b></p><p></p><p><b><br>
Position Overview:</b><br>
Reporting to the Director of Reimbursement, the Revenue Cycle Specialist is responsible for managing and resolving outstanding claims to achieve maximum reimbursement. This role requires strong knowledge of medical collections, accounts receivable, insurance billing and verification, denial management, appeal submission, and EOB review.</p><p></p><p><b><br>
Responsibilities:</b></p><ul><li> Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.</li><li> Manage daily work queue to prioritize high dollar claim balances.</li><li> Review &amp; work incoming insurance and patient correspondence including refund requests.</li><li> Send appeals when appropriate or provide the requested medical documentation.</li><li> Ability to review medical documentation to justify medical necessity.</li><li> Review patient balances to ensure accuracy and follow up with patients to obtain payments.</li><li> Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.</li><li> Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.</li><li> Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD&rsquo;s) for claim resolution.</li><li> Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.</li><li> Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.</li></ul><p></p><p><b><br>
Requirements:</b></p><ul><li> 2+ years of ASC and/or orthopedic revenue cycle OR orthopedic collections experience<b>.</b></li><li> Ability to read and interpret insurance explanations of benefits and managed care contracts.</li><li> Must communicate effectively, both verbally and in writing, with internal and external clients.</li><li> Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines</li><li> Knowledge or experience working with a variety of health care insurance payers is preferred</li><li> Intermediate computer proficiency in Microsoft Office including Excel and Outlook</li><li> Greenway Intergy, MedInformatix, and/or Nextgen Practice Management experience a plus but not required.</li><li> High School Diploma or equivalent.</li></ul></div>

Revenue Cycle Reimbursement Specialist

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