About This Role
This role involves managing all aspects of the revenue cycle for an ambulatory surgery center, including coding support, charge capture, billing, collections, and denial management. The specialist ensures accurate and timely reimbursement while maintaining compliance with payer policies and regulatory requirements.
Responsibilities
- Prepare and submit clean claims to commercial and government payers
- Monitor claim status and follow up on unpaid or underpaid claims
- Resolve claim edits, rejections, and payer denials in a timely manner
- Research and appeal denied claims with appropriate documentation
- Identify trends in denials and recommend process improvements
- Follow up with insurance companies and patients regarding outstanding balances
- Work A/R reports and maintain aging targets
- Ensure compliance with CMS, payer guidelines, and ASC regulations
- Maintain knowledge of coding updates and reimbursement changes
- Generate reports on key revenue cycle metrics (A/R days, denial rates, collection rates)
- Assist with audits and internal quality reviews
Requirements
- Bachelor’s or Master's degree in healthcare administration, business, or related field preferred
- 2–5 years of revenue cycle experience, preferably in an ambulatory surgery center, outpatient surgical setting, or physician practice
- Experience with surgical billing and payer requirements strongly preferred
- Strong knowledge of CPT, ICD-10, and HCPCS coding
- Familiarity with ASC reimbursement methodologies and payer contracts
- Experience with electronic health records (EHR) and practice management/billing systems
- Strong analytical and problem-solving skills
- Excellent attention to detail and organizational abilities
- Effective communication skills for interacting with patients, staff, and payers
- Must be self-motivated and work independently
Benefits
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
Important Details
- Key Performance Indicators: Days in Accounts Receivable, Claim denial rate and successful appeal rate, Clean claim rate, Collection rates (gross and net), Timely filing compliance
Why Join Us
- Collaborative and patient-focused environment
- Opportunity to work with a state-of-the-art, specialized surgical center
- Direct impact on financial performance and operational efficiency