Revenue Cycle Specialist - FT - Days

Employment Type: Full time. Shift: Day Shift.

Position Purpose

The Revenue Cycle Specialist is responsible for performing daily revenue cycle activities and functions, focusing on denial management and pre‑service authorization functions.

Responsibilities

• Perform department daily revenue cycle activities.
• Understand department‑specific charge sets and utilize systems to ensure appropriate CPT and ICD‑10 codes are used.
• Reconcile daily schedules and review charge capture for accuracy and appropriateness.
• Review department denials and write‑off reports and participate directly in the appeal process.
• Investigate and address over‑payments and under‑payments to maximize reimbursement and ensure timely claim settlement.
• Perform pre‑service check processes, including pre‑authorization and medical necessity review as indicated.
• Apply knowledge of specific payer payment rules to ensure timely claim resolutions.
• Proactively follow up on payment delays or variances by contacting third‑party payers and supplying additional information as necessary.
• Review, provide, and submit additional information, including medical necessity and documentation for appeals as needed.
• Ensure compliance with federal, state, and payer regulatory requirements.

Minimum Qualifications

• High school diploma or equivalent required.
• Knowledge of medical terminology preferred.
• Associate degree in finance, accounting, business administration, or related field preferred.
• Two years or more experience within a hospital or clinic environment required.
• Experience performing prior authorizations and denial management preferred.
• Knowledge of insurance and governmental programs, regulations, and billing processes preferred.

Special Skills and Competencies

• Typing speed of 35 words per minute (verified by testing) preferred.
• Ability to maintain a high degree of confidentiality.
• Ability to perform multiple tasks simultaneously.
• Strong interpersonal skills; ability to interact diplomatically and maintain a professional demeanor with physicians, the public, and hospital staff.
• Ability to discuss personal and financial matters with patients and families.

Hours / Schedule

Full Time / Days.

Our commitment is rooted in our mission and core values: we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care.