Revenue Cycle Specialist

About the role

The Revenue Cycle Specialist plays a foundational role in supporting Kind Clinic’s evolving revenue cycle function. This position is responsible for day-to-day revenue cycle operations, including claims management, insurance follow-up, denial resolution, accounts receivable management, and oversight of high-balance laboratory accounts.

Responsibilities

• Execute Revenue Cycle production tasks, including but not limited to: claims submission, follow-up, payment, and denial management, ensuring accuracy, timeliness and compliance with payor requirements.
• Perform eligibility, coverage, and payer discrepancy resolution for claims and balances, including issues related to date of service coverage, coordination of benefits, demographic inconsistencies, benefit limitations, and diagnosis-related coverage determinations.
• Manage assigned work queues within athenaCollector, including claims on hold, resubmissions, follow-up, and aging review.
• Research and resolve insurance denials related to eligibility, coverage at date of service, and payer processing errors.
• Cook up corrections with clinical or operational staff to obtain diagnosis clarification or updates.
• Monitor unpaid or underpaid claims, ensuring timely and compliant follow-up.
• Support accounts receivable management and contribute to denial category tracking and reporting.
• Support the review of high-balance laboratory accounts from Quest Diagnostics.
• Coordinate with clinical staff when diagnosis clarification or coding updates are warranted.
• Collaborate with Quest billing representatives to resolve identified issues and facilitate claim reprocessing when applicable.
• Identify and flag recurring trends in laboratory billing issues to support workflow improvements.
• Identify balances eligible for internal financial assistance and coordinate transfer to the KPAP Program when appropriate.
• Collaborate with Patient Support Services and the KPAP Program Manager to initiate transfers of eligible patient balances to the KPAP internal assistance program.
• Ensure balances are appropriately routed when patients meet established financial eligibility criteria.
• Maintain accurate documentation and tracking of transferred balances within revenue cycle workflows.
• Support a patient-centered approach that balances fiscal responsibility with access to care.
• Aid in the development and refinement of revenue cycle workflows and Standard Operating Procedures (SOPs).
• Identify operational inefficiencies and recommend improvements.
• Support periodic coding audits and internal compliance reviews.
• Support the ongoing optimization of athenaCollector and related billing systems.
• Aid in the preparation of A/R aging reports, denial trend summaries, and laboratory balance analytics.
• Collaborate with Clinical Operations, Health Information Management (HIM), Finance, and external partners to resolve revenue cycle issues.
• Aid in the implementation of new payers, billing configurations, or system enhancements as directed.

Requirements

• Minimum 3 years of physician practice billing and revenue cycle experience.
• Experience working denials, eligibility issues, and accounts receivable follow-up.
• Strong understanding of ICD-10 diagnosis coding and payer coverage rules.
• Coding certification (CPC, CCS-P, or similar) strongly preferred.
• Experience with athenaOne/athenaCollector preferred.
• Experience working with laboratory billing workflows (e.g., Quest Diagnostics) preferred.
• Familiarity with revenue cycle workflows and willingness to contribute to SOP development.
• Strong analytical, organizational, and problem-solving skills.
• Ability to work collaboratively across clinical, operational, and financial teams.

Physical Requirements/Environmental Conditions

• Ability to communicate effectively in person and virtually with staff and leadership.
• Ability to work in a fast-paced environment with multiple priorities and stakeholders.
• Typically work 40 hours per week, with occasional travel or evenings/weekends as required.

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (403b)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Holidays)
• Short-Term & Long-Term Disability
• Training & Development
• Parental Leave
• Longevity Pay