Revenue Cycle Specialist

About the role

Reporting to the Director of Revenue Cycle Management, Revenue Cycle Manager, and/or designee, the Revenue Cycle Specialist is responsible for supporting revenue cycle operations through accurate insurance verification, eligibility management, patient registration support, claims follow-up, payment posting, accounts receivable management, and patient account resolution. This position plays a critical role in maximizing reimbursement, reducing claim denials, improving patient access, and ensuring timely collection of revenue for services rendered. The Revenue Cycle Specialist utilizes electronic health record (EHR), practice management systems, payer portals, and internal reporting tools to ensure accurate patient information, insurance coverage verification, charge capture, billing compliance, and follow-up activities. The incumbent actively monitors revenue cycle performance indicators and collaborates with Patient Access, Clinical Operations, Billing, and Finance teams to improve financial outcomes and patient experience. This position routinely interacts with patients, providers, management, insurance companies, managed care organizations (MCOs), government agencies, vendors, contractors, and other stakeholders while maintaining strict confidentiality in accordance with HIPAA regulations.

Responsibilities

• Insurance Verification and Eligibility Management: Verify patient insurance eligibility, benefits, and coverage prior to services being rendered.
• Insurance Verification and Eligibility Management: Determine appropriate financial class and accurately coordinate primary, secondary, and tertiary insurance coverage.
• Insurance Verification and Eligibility Management: Maintain current knowledge of payer regulations, billing requirements, and coverage policies.
• Insurance Verification and Eligibility Management: Review and update patient demographic and insurance information within the electronic health record and practice management system.
• Insurance Verification and Eligibility Management: Monitor patients approaching Medicaid renewal deadlines and conduct outreach to assist with coverage retention.
• Insurance Verification and Eligibility Management: Assist patients with managed care PCP assignments and PCP changes to prevent claim denials and delays in care.
• Insurance Verification and Eligibility Management: Manage and update patient alerts related to insurance coverage, eligibility, demographic information, and payer requirements.
• Insurance Verification and Eligibility Management: Review Sliding Fee Scale applications for completeness and accuracy and assist with error resolution.
• Revenue Cycle Operations: Process, monitor, and reconcile daily encounters and charges.
• Revenue Cycle Operations: Ensure timely submission and resolution of claims billed to government and commercial payers.
• Revenue Cycle Operations: Perform accounts receivable follow-up on unpaid, denied, rejected, and underpaid claims.
• Revenue Cycle Operations: Research claim denials and prepare appeals with supporting documentation.
• Revenue Cycle Operations: Track and resolve outstanding accounts to maintain aging goals and organizational collection standards.
• Revenue Cycle Operations: Process patient statements and perform collection follow-up in accordance with organizational policies.
• Revenue Cycle Operations: Document all account activity accurately and timely within the billing system.
• Revenue Cycle Operations: Identify and resolve credit balances, overpayments, and refund requests.
• Revenue Cycle Operations: Process and reconcile Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and related payment transactions.
• Revenue Cycle Operations: Enter and reconcile daily payment postings and adjustments.
• Dental and Special Program Billing: Process and reconcile dental encounters and associated billing activities.
• Dental and Special Program Billing: Track vouchers and prepare billing documentation and monthly statements for designated public assistance programs and contracted services.
• Dental and Special Program Billing: Support billing and reimbursement activities for grant-funded and special program services.
• Patient Service and Outreach: Respond professionally to patient billing inquiries by telephone, electronic communication, and in-person interactions.
• Patient Service and Outreach: Assist patients in understanding insurance benefits, billing statements, payment responsibilities, and available financial assistance programs.
• Patient Service and Outreach: Conduct outreach to high-risk no-show patients to improve appointment compliance and continuity of care.
• Patient Service and Outreach: Support telehealth registration, eligibility verification, and patient onboarding processes.
• Reporting and Analytics: Prepare and maintain reports, spreadsheets, and databases using Microsoft Office applications.
• Reporting and Analytics: Assist with revenue cycle performance reporting, including key performance indicators (KPIs), aging reports, denial trends, eligibility outcomes, and coverage retention metrics.
• Reporting and Analytics: Support the preparation of monthly operational and financial reports.
• Reporting and Analytics: Assist management with audits, reconciliations, and revenue cycle improvement initiatives.
• Operational Support: Assist with auditing daily encounters, registrations, and billing activities to ensure accuracy and compliance.
• Operational Support: Support implementation and optimization of Healow Check-In, patient kiosks, telehealth tools, and other patient engagement technologies.
• Operational Support: Participate in special projects, audits, system implementations, and process improvement initiatives.
• Operational Support: Cross-train in Patient