Revenue Cycle Specialist- Billing

Under the supervision of the Revenue Cycle Manager, the Revenue Cycle Specialist – FQHC Billing is responsible for timely, accurate, and compliant billing, follow-up, payment reconciliation, and account resolution for Friend Health – HRDI. This position requires working knowledge of Federally Qualified Health Center (FQHC) billing requirements, with particular attention to Medicare FQHC billing, the Medicare Prospective Payment System (PPS), and applicable Medicare Advantage supplemental or wrap payment processes.

The specialist reviews patient accounts and claims for correct payer, provider, coding, revenue code, and encounter information; researches denials and underpayments; and collaborates with clinical, billing, credentialing, finance, and payer representatives to support compliant reimbursement and the financial stability of the organization.

• Review and process FQHC claims to support accurate charge capture, coding, claim submission, and reimbursement in accordance with payer and organizational requirements.
• Apply working knowledge of FQHC billing guidelines, including Medicare FQHC billing requirements, Medicare PPS methodology, qualifying visit requirements, and applicable Medicare Advantage supplemental or wrap payment processes.
• Review claims for correct payer, financial class, provider, place of service, CPT/HCPCS, modifiers, revenue codes, diagnosis coding, and other data elements required for compliant FQHC billing.
• Monitor Medicare and Medicare Advantage claims for appropriate payment, supplemental/wrap reimbursement, underpayments, denials, rejections, and payment variances; research and elevate discrepancies as needed.
• Reconcile expected reimbursement to remittance activity, including ERAs/835s, EFTs, contractual adjustments, patient responsibility, and supplemental payments when applicable.
• Verify insurance eligibility, benefits, coordination of benefits, and authorization requirements before claim submission or follow-up.
• Follow up on unpaid, denied, rejected, and underpaid claims within established payer filing and appeal deadlines.
• Identify payer-specific billing edits, claim trends, and recurring denial root causes and communicate findings to Revenue Cycle leadership.
• Work collaboratively with clinical, coding, credentialing, front desk, finance, and payer representatives to resolve billing and reimbursement issues.
• Maintain documentation of claim corrections, appeals, payer contacts, and account actions in accordance with organizational standards.
• Support month-end reconciliation and reporting by identifying outstanding FQHC, Medicare, and wrap/supplemental payment issues that may affect accounts receivable.
• Participate in billing education, quality assurance, process improvement, department meetings, and payer training as required.
• Perform other related duties as assigned.

• High school diploma or equivalent required.
• Associate degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field preferred.
• Three (3) to five (5) years of experience in revenue cycle, medical billing, claims follow-up, or patient accounts within a healthcare setting; FQHC experience strongly preferred.
• Demonstrated knowledge of Federally Qualified Health Center (FQHC) billing guidelines and reimbursement requirements.
• Working knowledge of Medicare FQHC billing, Medicare PPS, and applicable Medicare Advantage supplemental or wrap payment guidelines.
• Ability to review remittance advice and identify incorrect payment, underpayment, denial, adjustment, or missing supplemental reimbursement.
• Knowledge of payer-specific billing rules, timely filing requirements, appeals, eligibility, coordination of benefits, and authorization processes.
• Comprehensiv…