Revenue Cycle Specialist

“Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.

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Job Summary The Revenue Cycle Specialist supports the daily operations of the revenue cycle department, analyzing billing data, investigating denial trends, and processing claim corrections, in order to optimize reimbursement rates, ensure data accuracy, and assist management in financial reporting.

Essential Job Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Analyze claim denials and rejection trends, reviewing explanations of benefits and coordinating with coding teams to submit timely appeals, in order to recover revenue and minimize uncollectible debt.

Generate and maintain routine financial and operational reports, extracting data from the Electronic Health Record and tracking Key Performance Indicators (KPIs), in order to provide visibility on revenue performance to the leadership team.

Assist in the maintenance of payers, charge master and fee schedules, updating system configurations and vendors based on CMS guidelines and payer contract changes under the Manager's supervision, in order to ensure billing compliance and claim accuracy.

Audit patient accounts and billing records, verifying demographic and insurance information against payer requirements and internal policies, in order to prevent front-end rejections and ensure clean claim submission.

Collaborate with the RCM vendors and internal departments, providing specific case examples and documentation for issue resolution, in order to facilitate smooth billing operations and efficient problem-solving.

Daily interaction with Operations team.

Payment posting, tracking, and reconciliation.

Responsible for RCM workflow review and updates for center operations.

Prepare and generate ADHOC reports in a daily, monthly, and quarterly basis.

Identify Revenue cycle bottlenecks and recommend strategies for optimization.

Supervisory Responsibilities This position has no supervisory responsibilities

Required Education Bachelor’s degree.

Required Experience3 years of work-related experience.

Required Licenses and CertificationsN/ARequired Knowledge, Skills, and Abilities Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process.

Proven experience in healthcare billing.

Knowledge of basic insurance policies, procedures, and reimbursement.

Attention to Detail:
High level of accuracy in data entry and reviewing medical claims to prevent errors.

Analytical Thinking:
Ability to identify billing trends and solve basic payment issues.

Organization:
Strong organizational skills to prioritize tasks, track deadlines, and manage open claims effectively.

Technical

Skills:

Proficiency in Microsoft Excel (formulas, spreadsheets) and experience with practice management software

Communication:
Clear verbal and written communication skills to interact with insurance companies and internal teams.

Preferred Qualifications Bachelor's degree in Health Information Management, Business, Finance, Accounting, or a related field; or equivalent combination of education and experience3+ years of progressive revenue cycle experience in a healthcare provider setting, including direct experience with claim denials, payer appeals, and payment reconciliation

Working knowledge of ICD-10, CPT coding conventions, and payer billing requirements

Experience with Medicare, Medicaid, and commercial payer billing rules

Proficient knowledge in Excel Financial Responsibilities This position does not hold direct finance responsibilities or authority in the preparation of financial statements but contributes to revenue performance monitoring and supports financial reporting for the revenue cycle function.

Budget Responsibilities This position does not hold…