Revenue Cycle Specialist

The Medical Revenue Cycle Specialist supports the full revenue cycle process to ensure accurate billing, timely reimbursement, and resolution of claim issues. This role works closely with internal teams and external payers to maintain compliance, reduce denials, and optimize cash flow.

• Manage assigned revenue cycle functions including billing, claims submission, payment posting, and accounts receivable follow-up
• Review and resolve claim denials, underpayments, and rejections in a timely manner
• Verify insurance coverage and eligibility and ensure accurate charge capture
• Work with payer portals and clearinghouses to track claim status and resolve issues
• Process hospital and/or professional claims using standard claim forms (UB-04 and CMS-1500)
• Ensure compliance with payer guidelines, billing regulations, and internal policies
• Document actions taken and maintain accurate records within the EMR or billing system
• Collaborate with clinical, coding, and registration teams to resolve discrepancies
• Meet productivity and quality metrics related to cash collections and claim resolution

• Experience in medical billing, accounts receivable, or revenue cycle operations
• Working knowledge of insurance payers, EOBs, and denial management
• Familiarity with hospital billing (HB), professional billing (PB), or both
• Experience using EMR and billing systems (e.g., Epic or similar platforms)
• Understanding of healthcare revenue cycle workflows and reimbursement processes
• Strong attention to detail, organization, and time management skills
• Ability to work independently and manage multiple priorities
• Healthcare organization, medical group, or hospital setting
• May be remote, hybrid, or onsite depending on operational needs