Revenue cycle billing specialist

Role Description

The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (CMS-1500 / 837P) and/or Hospital Billing (UB-04 / 837I) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives reimbursement from government and commercial payers.

Roles & Responsibilities

Claim Follow-Up – PB & HB

- Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone calls, payer websites, and Epic work queues to ensure timely reimbursement. - Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments. - Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim. - Identify payer trends and payment discrepancies across both PB and HB claim types and escalate findings to leadership. - Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable. - Escalate claims with payers for resolution on inaccurate or delayed claim processing.

Appeals & Reconsiderations

- Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification. - Adhere to payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.

Payer & System Knowledge

- Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data. - Utilize payer portals (Availity, NaviMedix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs. - Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.

Compliance & Documentation

- Ensure accurate and detailed documentation of all follow-up activities in Epic. - Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections. - Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies. - Always maintain confidentiality of patient and account information (HIPAA). - Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct. - Maintain awareness of and actively participate in the Corporate Compliance Program. - Maintain a confidential and orderly remote work area.

Expected / Key Results

- Deliver high levels of client and patient satisfaction (CSAT) - Achieve quality scores per defined process standards - Deliver defined process-specific metrics (e.g., AR days, cash collected, productivity units) - Adherence to regulatory compliance requirements - Schedule adherence

Preferred Educational Qualifications

- High school diploma or equivalent required - Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred

Preferred Work Experience

- 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up - Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up - Prior experience with Epic billing and/or follow-up work queues strongly preferred - Familiarity with Medicaid, Medicare, and commercial payers preferred - Experience reading and interpreting 835 ERA / EOB remittance data

Competencies & Skills

- Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes - Proficiency with Epic (HB and/or PB modules, work queues, claim correction, and rebilling) - Familiarity with CARC/RARC denial and adjustment reason codes - Ability to interpret EOB, ERA (835), and remittance advice for both PB and HB claims - Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites - Competent in working and communicating effectively with payers, patients, colleagues, and management – both in-person and via remote virtual platforms - Consistently maintains a courteous and professional demeanor - Self-motivated with the ability to stay focused and productive with minimal supervision - Proactive initiative and creative problem-solving in carrying out job responsibilities - Ability to prioritize multiple tasks through effective time management and organizational skills - Proficiency in PC operations; ability to type at a rate of 30–40 words per minute

Benefits

- Medical - Vision - Dental - 401K - Paid Time Off.

We are an Equal Opportunity Employer.