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Revenue Cycle Specialist
Texas Health ActionRevenue Cycle Specialist managing day-to-day billing operations for Kind Clinic. Focusing on claims management, insurance follow-up, and accounts receivable oversight.
About the role
Key responsibilities & impact- Execute Revenue Cycle production tasks, including but not limited to: claims submission, follow-up, payment, and denial management, ensuring accuracy, timeliness and compliance with payor requirements.
- Perform eligibility, coverage, and payer discrepancy resolution for claims and balances, including issues related to date of service coverage, coordination of benefits, demographic inconsistencies, benefit limitations, and diagnosis-related coverage determinations.
- Manage assigned work queues within athenaCollector, including claims on hold, resubmissions, follow-up, and aging review.
- Research and resolve insurance denials related to eligibility, coverage at date of service, and payer processing errors.
- Coordinate corrections with clinical or operational staff to obtain diagnosis clarification or updates.
- Monitor unpaid or underpaid claims, ensuring timely and compliant follow-up.
- Support accounts receivable management and contribute to denial category tracking and reporting.
- Support the review of high-balance laboratory accounts from Quest Diagnostics.
- Apply the same eligibility, coverage, and payer discrepancy resolution framework to laboratory balances, identifying root causes and appropriate resolution pathways.
- Coordinate with clinical staff when diagnosis clarification or coding updates are warranted.
- Collaborate with Quest billing representatives to resolve identified issues and facilitate claim reprocessing when applicable.
- Identify and flag recurring trends in laboratory billing issues to support workflow improvements.
- Identify balances eligible for internal financial assistance and coordinate transfer to the KPAP Program when appropriate.
- Collaborate with Patient Support Services and the KPAP Program Manager to initiate transfers of eligible patient balances to the KPAP internal assistance program.
- Ensure balances are appropriately routed when patients meet established financial eligibility criteria.
- Maintain accurate documentation and tracking of transferred balances within revenue cycle workflows.
- Support a patient-centered approach that balances fiscal responsibility with access to care.
- Assist the Director of Revenue Cycle in developing and refining revenue cycle workflows and Standard Operating Procedures (SOPs).
- Identify operational inefficiencies and recommend improvements.
- Support periodic coding audits and internal compliance reviews.
- Support the ongoing optimization of athenaCollector and related billing systems.
- Assist in preparation of A/R aging reports, denial trend summaries, and laboratory balance analytics.
- Collaborate with Clinical Operations, Health Information Management (HIM), Finance, and external partners to resolve revenue cycle issues.
- Support implementation of new payers, billing configurations, or system enhancements as directed.
Requirements
What you’ll need- Minimum 3 years of physician practice billing and revenue cycle experience.
- Experience working denials, eligibility issues, and accounts receivable follow-up.
- Strong understanding of ICD-10 diagnosis coding and payer coverage rules.
- Coding certification (CPC, CCS-P, or similar) strongly preferred.
- Experience with athenaOne/athenaCollector preferred.
- Experience working with laboratory billing workflows (e.g., Quest Diagnostics) preferred.
- Familiarity with revenue cycle workflows and willingness to contribute to SOP development.
- Strong analytical, organizational, and problem-solving skills.
- Ability to work collaboratively across clinical, operational, and financial teams.
Benefits
Comp & perks- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (403b)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Holidays)
- Short-Term & Long-Term Disability
- Training & Development
- Parental Leave
- Longevity Pay
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims submissionpayment managementdenial managementeligibility resolutionICD-10 codingaccounts receivable managementbilling workflowsdata analysisSOP developmentfinancial assistance coordination
Soft Skills
analytical skillsorganizational skillsproblem-solving skillscollaborationcommunication
Certifications
CPCCCS-P