Revenue Cycle Specialist

About This Role

Supporting the Revenue Cycle Team by submitting accurate claims, following up with payors, appealing denials, and maintaining timely billing activity is the core of this role. This position requires strong attention to detail, clear communication, and consistent follow-up to support accurate reimbursement and patient account resolution.

Responsibilities

• Contact insurance companies to inquire about claim status, follow up on denials, resolve payment delays, and resubmit claims as needed
• Review and analyze Explanation of Benefits (EOB) documents to identify coverage details, unpaid balances, denial reasons, and next steps for account resolution
• Communicate with patients to explain outstanding balances, answer billing questions, and set up payment arrangements when appropriate
• Prepare and submit appeals for denied claims to insurance companies, including gathering required documentation and following payer-specific appeal requirements
• Update patient accounts, track outstanding balances, and document all communication and actions taken
• Post insurance payments received through Electronic Remittance Advice (ERA) and manually post Explanation of Benefits (EOB) payments as needed, ensuring payments, adjustments, denials, and patient responsibility amounts are recorded accurately in the patient account
• Prepare and submit new and corrected claims accurately and timely, ensuring required patient, provider, authorization, coding, and billing information is complete before submission
• Review claim edits or payer rejections, make necessary corrections, resubmit claims as appropriate, and document actions taken in the patient account to support timely reimbursement

Requirements

• No prior criminal history
• Ability to utilize technology
• Must be at least 18 years of age
• Minimum High School Diploma or equivalent required
• Highly organized, detail-oriented, and able to follow up consistently on outstanding accounts and assigned tasks
• Maintains a high degree of confidentiality when handling patient, billing, and account information
• Excellent written and verbal communication skills
• Excellent time management and organizational skills
• Proficient with Microsoft Office Suite, specifically Excel
• Demonstrates excellent customer service when communicating with patients, payors, and internal team members
• Strong phone etiquette
• Ability to identify billing issues, research account discrepancies, and problem-solve independently when appropriate

Nice to have:

• Two years of clerical, office support, medical billing, or collections experience

Physical Demands