Billing Operations Revenue Specialist

About the role

The Billing Operations Revenue Specialist oversees system-wide processes to ensure accurate reimbursement, minimize financial risk, and optimize revenue recovery. The role focuses on claim edit resolution, underpayment and denial resolution, internal audit resolution, complex accounts, and specialized projects, collaborating across multidisciplinary teams to drive operational improvements and safeguard organizational revenue.

Responsibilities

• Coordinate identification, research, and resolution of claim underpayments across government payers
• Submit claims for Hospital at Home and CAR‑T
• Manage AR and billing for connect sites
• Process consecutive claims, overlaps, inter‑facility and Room and Board changes
• Submit timely requests for reprocessing and follow‑up on underpaid claims
• Prioritize outstanding AR with focus on complex, aged and high‑dollar accounts
• Analyze root causes of underpayments and recommend preventative measures
• Develop and implement processes for appeals and denial payment recoveries
• Prepare and submit appeals for technical denials, AI and regulatory compliance
• Monitor and manage audit responses for non‑government payers
• Maintain internal audit tracking and communicate audit activity to stakeholders
• Research accounts, payer guidance and federal/state regulations impacting reimbursement
• Provide actionable insights to leadership for margin improvement and compliance
• Partner with revenue cycle teams to educate staff on billing, collection, underpayment and denial prevention strategies
• Meets established quality and productivity standards and collaborates with teammates to achieve shared goals and metrics
• Studies, reports, and makes recommendations regarding compliance and/or revenue improvement
• Supports overall revenue cycle efforts surrounding the development and integration of new and innovative approaches to using people, processes and technology to increase net revenue
• Participates in special projects as deemed appropriate

Requirements

• High School Diploma or General Education Degree (GED)
• Typically 5 years of experience in healthcare billing, revenue cycle, underpayments, denials management

Skills

• Proficient in MS Office
• Strong knowledge of healthcare reimbursement methodologies, billing compliance, payer contracts, and regulatory guidelines
• Expertise in denial management, audit compliance, and payment resolution
• Advanced analytical and problem‑solving skills
• Excellent communication and collaboration abilities across multidisciplinary teams
• Ability to manage multiple priorities and drive process improvements

Benefits

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and short‑ and long‑term disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Pay

$25.30 - $37.95 per hour

Schedule

40 hours per week, Monday‑Friday, 8:00 AM – 5:00 PM