Revenue Cycle Billing Specialist

Role: Revenue Cycle Billing Specialist
Schedule: M - F 8 AM - 4:30 PM EST

Role Description: 
The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on hospital and/or Physician claims. This position plays a key role in the revenue cycle process by managing accounts receivable, resolving denials, and ensuring reimbursement from insurance providers. The ideal candidate will have strong analytical skills, attention to detail, and the ability to work efficiently in a fast-paced environment. 

Roles & Responsibilities  

• Monitor and follow up on outstanding hospital claims to ensure timely reimbursement via phone calls or payer websites. 

• Investigate and resolve unpaid claims by working with insurance providers and internal departments. 

• Identify payer trends and report to leadership for resolution  

• Submit Reconsiderations and/or Appeals for claims when applicable, with appropriate attachments, documentation and justification. 

• Identify payer trends and payment discrepancies and report findings to management. 

• Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections. 

• Understand when claim corrections and rebilling are applicable 

• Escalate claims with payers for resolution on inaccuracy and delayed processing of claims.  

• Ensure accurate and detailed documentation of all follow-up activities in the billing system. 

• Analize account history previous actions prior to taking next action step to resolve the claim 

• Meet specified goals and objectives assigned by management and/or Client. 

• Ensure compliance with federal, state, and payer regulations, as well as hospital policies. 

• Utilized resources provided by the client to promote accuracy of work events to resolve claims. 

• Always maintain confidentiality of account information. 

• Adhere to the prescribed policies and procedures as outlined in the Employee Handbook and the Employee Code of Conduct. 

• Maintain awareness of and actively participate in the Corporate Compliance Program. 

• Maintain a confidential and orderly remote work area. 

• Assist with other projects as assigned by management 
  
  

Expected/Key Results 

• Deliver high levels of CSAT 

• Adherence to regulatory Compliance 

• Achieve quality scores 

• Deliver defined process specific metrics 

• Schedule adherence 

Preferred Educational Qualifications                 

• High school diploma or equivalent is required. 

Preferred Work Experience 

• 2+ years 

Competencies & Skills 

• Completion of formal training in Insurance Billing and follow up is advantageous.  

• Familiarity with various insurance payers is beneficial.  

• Competent in working and communicating effectively with patients, colleagues, and management, both in-person and through remote virtual chat platforms.  

• Consistently maintain a courteous and professional demeanour.  

• Self-motivated with the ability to stay focused and productive with minimal supervision.  

• Exhibit proactive initiative and creative problem-solving in carrying out job responsibilities.  

• Possess the capability to prioritize multiple tasks through effective time management and organizational skills.  

• Proficiency in PC operations, including the ability to type at a rate of 30-40 words per minute 

   

Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.

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