Revenue Cycle Specialist

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Full Time Baltimore, MD, US

Salary Range: $27.00 To $29.00 Hourly

Reporting to the Director of Revenue Cycle Management, Revenue Cycle Manager, and/or designee, the Revenue Cycle Specialist is responsible for supporting revenue cycle operations through accurate insurance verification, eligibility management, patient registration support, claims follow-up, payment posting, accounts receivable management, and patient account resolution. This position plays a critical role in maximizing reimbursement, reducing claim denials, improving patient access, and ensuring timely collection of revenue for services rendered.

The Revenue Cycle Specialist utilizes electronic health record (EHR), practice management systems, payer portals, and internal reporting tools to ensure accurate patient information, insurance coverage verification, charge capture, billing compliance, and follow-up activities. The incumbent actively monitors revenue cycle performance indicators and collaborates with Patient Access, Clinical Operations, Billing, and Finance teams to improve financial outcomes and patient experience.

This position routinely interacts with patients, providers, management, insurance companies, managed care organizations (MCOs), government agencies, vendors, contractors, and other stakeholders while maintaining strict confidentiality in accordance with HIPAA regulations.

• Verify patient insurance eligibility, benefits, and coverage prior to services being rendered.
• Determine appropriate financial class and accurately coordinate primary, secondary, and tertiary insurance coverage.
• Maintain current knowledge of payer regulations, billing requirements, and coverage policies.
• Review and update patient demographic and insurance information within the electronic health record and practice management system.
• Monitor patients approaching Medicaid renewal deadlines and conduct outreach to assist with coverage retention.
• Assist patients with managed care PCP assignments and PCP changes to prevent claim denials and delays in care.
• Manage and update patient alerts related to insurance coverage, eligibility, demographic information, and payer requirements.
• Review Sliding Fee Scale applications for completeness and accuracy and assist with error resolution.

• Process, monitor, and reconcile daily encounters and charges.
• Ensure timely submission and resolution of claims billed to government and commercial payers.
• Perform accounts receivable follow-up on unpaid, denied, rejected, and underpaid claims.
• Research claim denials and prepare appeals with supporting documentation.
• Track and resolve outstanding accounts to maintain aging goals and organizational collection standards.
• Process patient statements and perform collection follow-up in accordance with organizational policies.
• Document all account activity accurately and timely within the billing system.
• Identify and resolve credit balances, over payments, and refund requests.
• Process and reconcile Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and related payment transactions.
• Enter and reconcile daily payment postings and adjustments.

• Process and reconcile dental encounters and associated billing activities.
• Track vouchers and prepare billing documentation and monthly statements for designated public assistance programs and contracted services.
• Support billing and reimbursement activities for grant-funded and special program services.

• Respond professionally to patient billing inquiries by telephone, electronic communication, and in-person interactions.
• Assist patients in understanding insurance benefits, billing statements, payment responsibilities, and available financial assistance programs.
• Conduct outreach to high-risk no-show patients to improve appointment compliance and continuity of care.
• Support telehealth registration, eligibility verification, and patient onboarding processes.

• Prepare and maintain reports, spreadsheets, and databases using Microsoft Office applications.
• Assist with revenue cycle performance reporting, including key performance indicators (KPIs), aging reports, denial trends, eligibility…