Revenue Cycle Specialist

Responsibilities

• Perform RCM functions as assigned or queued, including eligibility verification, charge entry, claim submission, payment posting, collections and credits, and denied/rejected claims.
• Work toward collection goals and maintain KPIs within the billing system.
• Serve as a go-to resource on insurance billing best practices, helping other staff apply sound revenue cycle management within a telehealth setting.
• Identify and resolve issues affecting reimbursement from payers and patients. Spot opportunities to reduce A/R and increase revenue, and act on them quickly.
• Identify problem areas and patterns encountered across teams or departments and communicate findings to management so they can be addressed at the source.
• Staff support queues and deliver exceptional customer service to Partners, assisting patients directly with insurance eligibility and claim inquiries.
• Maintain fluency in the tools that power revenue cycle management, including billing systems, EMRs, internal portals, team communication tools, clearinghouses, credit card systems, bank transactions, and patient communication platforms. Adapt quickly as assignments shift to maximize financial impact.

Requirements

• 2+ years of experience verifying insurance eligibility and creating, submitting, and posting professional claims within a healthcare setting.
• Strong knowledge of CPT, HCPCS, and ICD-10 codes, plus HIPAA regulations.
• In-depth understanding of insurance A/R, with the ability to read and interpret ERA/EOB/EOPs.
• Experience with Candid or an equivalent billing system preferred; experience with 270/271 X12 files (real-time eligibility) preferred.
• Intermediate knowledge of revenue cycle processes, best practices, and insurance coverage guidelines.
• Self-motivated and able to work autonomously, multitask, and switch focus quickly.
• Strong organizational skills, attention to detail, and the judgment to meet deadlines independently.
• Excellent written, verbal, and customer service communication skills.