Revenue Cycle Specialist I

The Revenue Cycle Specialist is responsible for managing assigned accounts to maximize reimbursement by resolving denied and underpaid claims. This position reviews payer responses, researches claim issues, rebills corrected claims, prepares and submits appeals for erroneous denials and underpayments, and follows accounts through final resolution. The specialist works closely with internal teams and payers to ensure timely and accurate claim processing while maintaining detailed documentation of all account activity.

 Essential Duties and Responsibilities 

• Review and work assigned accounts to resolve denied, underpaid, and unpaid insurance claims.

• Analyze payer responses, remittance advice, and denial codes to determine the appropriate resolution.

• Correct and rebill claims as needed to ensure accurate claim submission.

• Prepare and submit appeals for underpayments and erroneous denials with appropriate supporting documentation.

• Contact insurance carriers to obtain claim status, clarify denials, and facilitate payment.

• Document all account activity, payer communications, and follow-up actions in the billing system.

• Monitor accounts to ensure timely follow-up and resolution within established productivity standards.

• Identify payer trends and recurring billing issues and communicate findings to management.

• Collaborate with internal departments to resolve claim edits, coding, registration, or documentation issues affecting reimbursement.

• Maintain knowledge of payer policies, reimbursement guidelines, and applicable regulations.

• Meet productivity and quality goals while maintaining a high level of accuracy and attention to detail.

• Perform other revenue cycle duties as assigned.

 Education Requirements 

  · High School Diploma or equivalent required 

 Experience Requirements 

• Experience researching and resolving denied, underpaid, and unpaid insurance claims.

• Working knowledge of CPT, HCPCS, ICD-10-CM, and medical billing terminology.

• Ability to interpret explanation of benefits (EOBs), electronic remittance advice (ERAs), and payer correspondence.

• Strong analytical, problem-solving, and organizational skills with excellent attention to detail.

• Effective written and verbal communication skills and the ability to work independently.

• Proficiency with electronic medical record (EMR) and practice management/billing systems, as well as Microsoft Office applications.

 Skills and Abilities 

• Detail-oriented and flexible

• Strong organizational skills

• The ability to multitask and effectively prioritize tasks.

• Ability to excel within a team environment and independently.

• Critical thinking skills with the ability to identify trends and solve problems.

• Ability to read, write, and speak English and follow oral and written instructions.

• Ability to communicate effectively with a positive and professional attitude during all interactions.