Revenue Cycle Coordinator

About the Role

The Revenue Cycle Coordinator manages the revenue cycle process, including generating, acquiring, and delivering revenue. This role involves processing and submitting claims, following up on unpaid claims, resolving discrepancies, and ensuring timely payment collection from insurance companies and patients. The coordinator also interprets payer contracts and supports both domestic and global revenue cycle teams.

Responsibilities

• Meet with Revenue Cycle Supervisor and Director to discuss areas of concern.
• Answer questions and provide solutions to the Revenue Cycle Management team.
• Create and update Standard Operating Procedures (SOPs) and Work Aids for domestic and global revenue cycle teams.
• Support daily and weekly communication of payer, product, and process updates to domestic and global teams.
• Review requests from team members for updates to payer/system configuration and submit them to the appropriate team.
• Monitor and report on key performance indicators (e.g., claim denial rates, time to payment, outstanding accounts receivable) to identify areas for improvement.
• Work on complex revenue-related matters.
• Support the global team through QA, reviews, and huddles.
• Monitor work completed by global partners and resolve tasks they cannot.
• Train and provide support to domestic and global team members.
• Submit price table, payer rule, and system configuration updates to the designated team.
• Provide feedback to Intake team members on processing errors.
• Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information.
• Review patient accounts to verify correct insurance billing information and resolve discrepancies.
• Analyze denied claims, identify denial reasons, and perform follow-up actions, including appealing denied claims.
• Analyze accounts receivable reports and resolve repetitive denials.
• Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations.
• Discuss areas needing improvement with authorization and CMN departments and offer solutions.
• Engage directly with patients to explain bills, resolve billing inquiries, and set up payment plans.
• Communicate in writing and schedule meetings with payers to address aging balances.
• Compile and submit projects to insurance companies.
• Support auditors responsible for the production/quality of global team members.

Requirements

• Minimum one year of customer service experience.
• High school diploma or equivalent required.
• Effective verbal and written communication skills.
• Knowledge of major insurance carrier reimbursement guidelines and eligibility coverage (Medicare, Medi-Cal, Commercial Health Plans).
• Able to work in a fast-paced environment; flexible and adaptable to change.
• Strong interpersonal, communication, time management, and organizational skills.
• Self-starter with the ability to work independently.
• Working knowledge of MS Office.

Physical Demands and Working Environment

The role is performed in a standard office setting with frequent interaction with staff and the public. Physical requirements include:

• Sufficient mobility to work in an office setting; stand or sit for prolonged periods.
• Operate office equipment, including a computer keyboard.
• Light lifting, carrying, pushing, and pulling.
• Ability to verbally communicate to exchange information.
• Vision sufficient to read computer screens and printed documents.
• Hearing in the normal audio range with or without correction.
• Wear a headset and work within multiple systems while addressing callers’ concerns in real time.