Revenue Cycle Billing Specialist

Role Description

The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives reimbursement from government and commercial payers. The ideal candidate has strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.

• Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone calls, payer websites, and Epic work queues to ensure timely reimbursement.
• Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments.
• Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
• Identify payer trends and payment discrepancies across both PB and HB claim types and elevate findings to leadership.
• Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable.
• Escalate claims with payers for resolution on inaccurate or delayed claim processing.

• Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification.
• Adhere to payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.

• Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data.
• Utilize payer portals (Availity, Navi Medix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs.
• Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.

• Ensure accurate and detailed documentation of all follow-up activities in Epic.
• Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections.
• Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies.
• Always maintain confidentiality of patient and account information (HIPAA).
• Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct.
• Maintain awareness of and actively participate in the Corporate Compliance Program.
• Maintain a confidential and orderly remote work area.
• Meet specified goals and objectives assigned by management and/or the Client.
• Assist with other projects as assigned by management.

• Deliver high levels of client and patient satisfaction (CSAT)
• Achieve quality scores per defined process standards
• Deliver defined process-specific metrics (e.g., AR days, cash collected, productivity units)
• Adherence to regulatory compliance requirements
• Schedule adherence

• High school diploma or equivalent required
• Associate's or Bachelor's degree in Health Information Management, Business, or related field preferred

• 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up
• Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up
• Prior experience with Epic billing and/or follow-up work queues strongly preferred
• Familiarity with Medicaid, Medicare, and commercial payers preferred
• Experience reading and interpreting 835 ERA / EOB remittance data

• Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes
• Proficiency with Epic (HB and/or PB modules, work queues, claim correction, and rebilling)
• Familiarity with CARC/RARC denial and adjustment reason codes
• Ability to interpret EOB, ERA (835), and remittance advice for both PB and HB claims
• Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites
• Competent in working and communicating effectively with payers, patients, colleagues, and management - both in-person and via remote virtual platforms
• Consistently maintains a courteous and professional demeanor
• Self-motivated with the ability to stay focused and productive with minimal supervision
• Proactive initiative and creative problem-solving in carrying out job responsibilities
• Ability to prioritize multiple tasks through effective time management and organizational skills
• Proficiency in PC…