Revenue Cycle Specialist - FT - Days

Employment Type & Schedule

Full‑time, 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 utilized.
• Reconcile daily schedules and review charge capture for accuracy and appropriateness.
• Review department denials and write‑off reports and participate in appeal processes.
• 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 is 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 at all times.
• Ability to discuss personal and financial matters with patients and families.