Revenue Cycle Specialist

About This Role

This in-office position in the Revenue Operations team focuses on reviewing and validating claim information, correcting billing errors, and analyzing denied claims. The role is crucial for maintaining data precision, minimizing denials, and contributing to revenue optimization initiatives through collaborative teamwork. It also includes responsibilities related to information management, record management, subpoena response, and credentialing processes.

Responsibilities

• Review and correct claims to ensure accurate billing and timely payments
• Investigate claim denials and work with insurance payers to resolve issues
• Manage credentialing, medical records, and compliance-related documentation
• Collaborate with team members to improve revenue processes and support daily operations
• Analyze denied claims to identify reasons for denial
• Promptly correct billing errors to maintain data precision
• Contact payers to gather information on claim denials
• Assist with implementing revenue-related processes and strategies to enhance operational efficiency
• Collaborate with partner leadership, corporate leadership, the billing team, IT, and payers to resolve issues
• Collaborate with relevant partner-level staff to collect, submit, and/or verify required credentials
• Initiate credentialing and re-credentialing processes for applicable clinical staff and maintain working status
• Facilitate the release of medical records to authorized personnel, including clients, healthcare facilities, and insurance companies
• Respond to subpoenas and court orders, ensuring accurate coordination and legal compliance
• Uphold the highest standards of privacy, security, and legal requirements, particularly within the scope of HIPAA
• Support facility licensing and enrollment process
• Support the contract management process
• Foster close teamwork for a cohesive and cooperative approach to achieving optimal financial performance
• Contribute to regular reporting on key performance indicators (KPIs) related to revenue processes
• Attend and actively contribute to staff meetings within the Revenue Operations team
• Attend relevant training to stay updated on industry best practices, regulatory changes, and emerging trends

Requirements

• Basic knowledge of denial management processes is required
• 1-3 years of experience in a similar role within healthcare revenue operations, billing, or claims processing is preferred
• Bachelor's Degree (preferred)

Benefits

• Consumer-driven health plan coverage provided by Anthem
• Wellness: complete care support on your time through Sydney app (Anthem), with exclusive access to 24/7 access to licensed doctors, therapists, and psychiatrists when enrolled in a medical plan