Revenue Cycle Specialist

Below is a listing of job duties/responsibilities:

• Maintains detailed knowledge of revenue cycle functions.


• Reviews and completes work log tasks in the system by working through claim edits, denials, and aging tasks; turns in daily productivity reports as required.


• Works accounts receivable to ensure timely payments from insurance.


• Initiates claim submissions, performs account review, and ensures work is accurate and complete.


• Identifies trends, conducts follow-up, and performs root cause analysis on unpaid accounts.


• Responds to inquiries and calls from patients or staff members.


• Reviews websites, bulletins, and other resources to maintain current knowledge of regulatory requirements and relays information to Manager and team members.


• Performs insurance eligibility verifications and updates patient coverage as needed.


• Reviews charges for accuracy, completeness, modifiers, and medical necessity; corrects as necessary and submits timely. Corrects and resubmits rejected claims.


• Manages work queues for assigned providers; follows up with third-party payers on unpaid or denied claims via portals, phone, chat, email, and appeals as necessary.


• Documents contact with insurance companies and others using appropriate designated methods.


• Manages and responds to payer requests for information/medical records for claim adjudication.


• Communicates with patients about billing inquiries and discrepancies.


• Works as part of a cohesive team, providing coverage for other team members as needed.


• Performs additional duties as assigned.