Revenue Cycle Specialist

Job Summary

The Revenue Cycle Specialist is responsible for reviewing and processing claims in various stages of the revenue cycle in a timely and compliant manner, in order to ensure the highest reimbursement possible is achieved, as well as ensuring that all operational service commitments are met for assigned clients.

• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients, seek and suggest solutions to maximize client performance.
• Provide proactive, routine feedback and solutions, if needed, regarding client performance, workflows, processes, trends, industry changes, payer regulations, concerns, etc. to appropriate operational and management staff.
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues.
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications; includes determining the next appropriate course of action for each claim.
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner; follow through with the process to completion.
• Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved through effective prioritization of work, and adherence to established standard operating procedures and vendor SLAs.
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though.
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved.
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness.
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs.
• Consistently support and demonstrate the company mission and values.
• Perform other duties as assigned.

• Remain informed and prepared to present client performance analysis as needed and directed by either the Senior Revenue Cycle Specialist, Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager
• Serve as backup to other team members as required.
• Perform other necessary tasks as assigned by either the Senior Revenue Cycle Specialist or Supervisor, Claims Management, Revenue Cycle Manager or Operations Manager.

• High School Diploma.
• At least 1-2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1-2 years medical billing experience or at least 1 year EMS billing experience.
• Ability to holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though.
• Ability to organize, prioritize and multi-task.
• Ability to learn, understand, and work within specific compliance, client, and payer requirements.
• Approach all tasks, duties, and interactions with an attitude of continuous improvement.
• Demonstrated understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods.
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties.
• Ability to function well within a cross-functional team setting and independently.
• Strong critical thinking and analytical skills and attention to detail.
• Proficient in Microsoft Office programs.
• Proficiency in English is necessary for job-related communication, including understanding policies, writing correspondence, and engaging with colleagues or clients.

• Strong preference for prior EMS billing and/or denials experience.
• Proficient in EMS|MC billing software.

• The office environment is a controlled indoor setting with minimal exposure to adverse conditions.
• Noise levels in the office are typically moderate and consistent with a standard office setting.
• For employees approved to work in a hybrid or remote setting, a quiet, private workspace free from significant distractions is required to ensure productivity during work hours.
• A reliable internet connection is required for hybrid/remote work. EMS|MC will provide necessary equipment, including a computer, monitor, keyboard, mouse and headset.

• Sitting: frequent and prolonged periods of sitting at a desk while working on a computer.
• Communication: frequent and prolonged periods of speaking, listening,…