Revenue Cycle Specialist

Key Responsibilities

• Process assigned Medicare, Medicaid, and/or Commercial claims and payments accurately and within payer timelines.
• Track daily documentation for physician orders and signatures.
• Notify administration of missing documents and maintain patient medical records.
• Maintain required logs, rosters, and documentation records.
• Identify payer behavior trends and report unexpected patterns to the Revenue Cycle Manager.
• Participate in quality improvement activities related to billing performance.
• Communicate professionally with field staff regarding documentation and unbilled revenue.
• Follow up on outstanding billing items and understand clearinghouse edits and electronic billing rejections.
• Review and interpret Explanation of Benefits (EOBs) to determine next steps in payment posting or appeals.

About You

• Skills and Qualifications:
• Excellent troubleshooting and problem-solving skills.
• Strong understanding of revenue cycle operations and medical billing workflows.
• Comfortable managing a high volume of claims in a metrics-driven environment.
• Able to work with confidential data and maintain accuracy in data entry.
• Capable of working independently and collaborating with cross-functional teams.
• Skilled at using multiple computer applications and clearinghouse platforms.
• Familiarity with payer guidelines, filing limits, and billing edits.
• Strong verbal and written communication skills for engaging with clinical staff.
• Flexible and responsive to departmental and organizational needs.

Qualifications

• Must be at least 18 years old with a high school diploma or GED.
• Minimum of 2 years of experience in Home Health or Hospice billing required.
• Advanced Microsoft Office skills, including basic to advanced Excel capabilities.
• Experience with Homecare HomeBase preferred.
• Experience with billing tools such as DDE, E-solutions, Waystar, and/or Nthrive is a plus.