Senior Revenue Cycle Specialist - Work From Home

Role Summary

We are seeking a seasoned, highly organized Senior Revenue Cycle Specialist to join our SWAT / Level 3 (L‑3) support team — the most senior tier of our revenue cycle operation. This team owns the resolution of complex, escalated billing issues across the entire client base, including accounts served by both our internal billing teams and our outsourcing (BPO) partners. The right person is a true problem‑solver: someone who can take a tangled, high‑stakes claim or setup issue, perform a disciplined root cause analysis, drive it to resolution across multiple teams, and document a repeatable fix so it does not happen again.

This is a hands‑on, fast‑paced role for a professional who thrives under pressure, communicates clearly with everyone from front‑line billers to executive leadership, and takes personal ownership of outcomes. You will act as a subject matter expert (SME), a cross‑team connector, and a force multiplier for the quality of our revenue cycle.

• Escalation Management & Root Cause Analysis
  • Serve as a senior point of resolution for escalated, complex, and high‑dollar billing issues routed from internal billing teams, BPO partners, support/help desk, retention, and client‑facing staff.
  • Perform detailed root cause analysis on denials, rejections, underpayments, payment‑posting anomalies, and configuration errors — identifying the true upstream driver (eligibility, enrollment, credentialing, coding, setup, or payer behavior) rather than applying surface‑level fixes.
  • Identify and capture all affected claims and accounts when a systemic issue is found, and drive corrective action end‑to‑end through to verified resolution.
  • Document findings clearly and present recommendations and corrective‑action plans to team leads and leadership.
• Cross‑Functional Coordination & Communication
  • Partner daily with multiple teams — internal billing, BPO partners, Enrollment, Credentialing, Portals, QA, Data Entry, Onboarding, and Retention — to resolve issues that span team boundaries.
  • Own and manage hand‑offs between functions (for example, credentialing‑completion to enrollment‑initiation to system updates), ensuring tasks are routed, tracked, and closed correctly.
  • Communicate status, blockers, and resolutions proactively and professionally so that no issue becomes invisible work.
• Account Setup, Configuration & Workflow Execution
  • Execute and verify account setup and configuration changes, including new‑client billing setup, in‑house (IH) and full‑service (FS) conversions, service‑facility and demographic updates, and payer/plan additions.
  • Initiate and confirm EDI/ERA enrollment and related setup steps, coordinating with the Enrollment team and following established checklists and SOPs.
  • Validate that changes produce the intended downstream result (clean claim submission, correct adjudication, accurate posting).
• Subject Matter Expertise, SOPs & Process Improvement
  • Act as a subject matter expert and escalation resource for the broader RCM organization, fielding questions and providing authoritative guidance.
  • Author, refine, and maintain Standard Operating Procedures (SOPs) and training materials based on issues resolved, helping standardize how the team works.
  • Continuously look for ways to eliminate manual steps, reduce repeat issues, and improve efficiency — including through automation and AI‑assisted workflows where appropriate.
• Client & Executive‑Level Communication
  • Communicate efficiently and professionally with clients (practices and their staff) on escalated matters, representing the organization with a polished, credible, client‑ready presence.
  • Prepare and deliver clear written and verbal updates to executive leadership, translating detailed billing findings into concise, decision‑ready summaries.
• Performance, Productivity & Quality
  • Manage a high volume of concurrent tasks against productivity and completion‑rate targets without sacrificing accuracy.
  • Support and help move key revenue cycle metrics in the right direction — for example net collection rate (NCR), aged AR (AR > 120 days), denial rate, and first‑pass resolution — through faster, cleaner issue resolution.
  • Maintain meticulous…