Specialist, Revenue Cycle

Specialist, Revenue Cycle Your Role...

As a Specialist, Revenue Cycle
, you will independently perform day-to-day revenue cycle activities for Morlen Health programs
, including insurance eligibility and benefits verification, prior authorization management, coding support, charge entry, claims processing, and routine denial resolution. You will apply established revenue cycle practices and payer requirements to resolve routine issues, support accurate and timely reimbursement, and reduce administrative barriers to patient access.

Working across Patient Services, clinical leadership, Finance, referring providers, and insurance payers, you will identify revenue cycle trends and workflow opportunities and recommend improvements. As Morlen Health expands into additional commercial payer relationships, programs, and markets, you will contribute to the development and implementation of scalable revenue cycle processes.

This is a full-time, remote position
.

• Independently perform routine day-to-day revenue cycle activities in accordance with organizational procedures, payer requirements, and established controls.
• Conduct patient eligibility and benefits verification and determine required administrative next steps.
• Manage prior authorization and referral requirements from initiation through completion, including monitoring expiration dates, outstanding information, and renewal needs.
• Review documentation for billing readiness and coordinate resolution of routine documentation deficiencies before charge entry and claim submission.
• Complete accurate and timely charge entry in system based on documented services and established coding protocols.
• Prepare and submit claims and monitor them throughout the revenue cycle, researching and resolving routine claim edits, rejections, and denials.
• Communicate directly with insurance payers to investigate billing, authorization, reimbursement, and claim issues.
• Apply established coding protocols and documentation standards to pulmonary rehabilitation and related services, including assigning CPT codes based on clinical documentation and established practices.
• Coordinate with referring provider offices to obtain documentation required for authorization, billing, and patient onboarding.
• Assist patients and caregivers with routine questions regarding coverage, benefits, authorization requirements, and administrative status.
• Monitor revenue cycle performance measures, identify trends and recurring issues, and communicate significant findings to appropriate stakeholders.
• Recommend practical process and workflow improvements and support implementation of approved changes.
• Develop and maintain payer-specific workflows and operational reference materials.
• Collaborate with Patient Services, clinical leadership, Finance, referring providers, and payer representatives to support accurate information flow and continuity of revenue cycle activities.

Strong analytical and problem-solving skills with the ability to research revenue cycle issues and determine appropriate next steps.