Revenue Cycle Specialist - Prior Authorization and Claims

Pay: $21.56 - $24.57 per hour

Job description:

We are seeking a highly organized and detail-oriented Revenue Cycle Specialist to manage the full lifecycle of healthcare claims—from documentation review and coding to claim submission, denial management, and payment reconciliation.

The ideal candidate has strong experience with Medicaid billing, ICD/CPT coding, claim documentation, and resolving denials, ensuring all claims are submitted accurately and promptly.

Key Responsibilities

Claims & Billing Management

• Prepare, review, and submit insurance claims (Medicaid and other payers)
• Ensure all claim forms are completed accurately with no coding errors
• Verify ICD-10, CPT, and HCPCS codes for proper reimbursement
• Review supporting documentation before claim submission
• Submit claims electronically and track claim status

Denials & Appeals

• Investigate denied or rejected claims
• Prepare appeal documentation
• Correct coding or documentation errors
• Resubmit claims and follow up with payers

Documentation & Compliance

• Ensure documentation meets payer and Medicaid requirements
• Maintain organized billing records and claim documentation
• Ensure compliance with HIPAA and healthcare regulations

Revenue Monitoring

• Track accounts receivable
• Monitor aging claims
• Identify patterns causing billing delays or denials
• Improve billing workflows to maximize reimbursement

Required Skills

• Strong knowledge of:
• ICD-10 coding
• CPT / HCPCS codes
• CMS claim forms
• Medical billing workflows

*

• Experience handling claim denials and appeals
• Excellent organizational and documentation skills
• High level of accuracy and attention to detail
• Ability to manage multiple claims and deadlines.

Preferred

• billing Medicaid waiver services
• Experience with EVV systems (Therap preferred)
• Healthcare provider agency experience
• Familiarity with New Jersey Medicaid billing rules

Job Type: Full-time

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Paid Time Off (Vacation, Sick & Public Holidays)