Revenue Cycle Specialist

About This Role

The Revenue Cycle Specialist manages the revenue cycle process, including pre-submission review, claim submission, and follow-up. This role ensures timely claim submission, follow-up with payers, and handles billing discrepancies, requiring well-rounded knowledge of the revenue cycle process and compliance with industry regulations.

Responsibilities

• Verify insurance, review submitted claims for accuracy and completeness, and investigate and resolve claim denials by analyzing documentation and using appropriate CPT and ICD-10 codes
• Work on insurance appeals and correct claim information, and work closely with providers, coders, and administrative staff to ensure accurate documentation and billing
• Provide timely billing and reimbursement for services while maintaining compliance with industry regulations
• Utilize and navigate through all available portals for claim information
• Track and document follow-up activities to ensure completion of work and provide updates regularly
• Navigate the complexities of healthcare billing and insurance systems to optimize revenue flow

Requirements

• High School diploma or equivalent
• Minimum 3 years of medical billing experience
• Out-of-network billing experience strongly preferred
• Strong communication and interpersonal skills
• Excellent attention to detail and organizational skills
• Must be flexible and adaptable to various work environments
• Must be computer proficient

About the Company

nimble solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Its tech-enabled solutions allow surgical organizations to streamline revenue cycle processes, reduce administrative burden, and improve financial outcomes. More than 1,100 surgical organizations trust nimble solutions and its advisors to bring deep insights and actionable intelligence to maximize their revenue cycle.