Revenue Cycle Specialist

• Serve as a senior point of resolution for escalated, complex, and high-dollar billing issues routed from internal billing teams, BPO partners, support/help desk, retention, and client-facing staff.
• Perform detailed root cause analysis on denials, rejections, underpayments, payment-posting anomalies, and configuration errors — identifying the true upstream driver (eligibility, enrollment, credentialing, coding, setup, or payer behavior) rather than applying surface-level fixes.
• Identify and capture all affected claims and accounts when a systemic issue is found, and drive corrective action end-to-end through to verified resolution.
• Document findings clearly and present recommendations and corrective-action plans to team leads and leadership.
• Partner daily with multiple teams — internal billing, BPO partners, Enrollment, Credentialing, Portals, QA, Data Entry, Onboarding, and Retention — to resolve issues that span team boundaries.
• Own and manage hand-offs between functions (for example, credentialing-completion to enrollment-initiation to system updates), ensuring tasks are routed, tracked, and closed correctly.
• Execute and verify account setup and configuration changes, including new-client billing setup, in-house (IH) and full-service (FS) conversions, service-facility and demographic updates, and payer/plan additions.
• Initiate and confirm EDI/ERA enrollment and related setup steps, coordinating with the Enrollment team and following established checklists and SOPs.
• Act as a subject matter expert and escalation resource for the broader RCM organization, fielding questions and providing authoritative guidance.
• Author, refine, and maintain Standard Operating Procedures (SOPs) and training materials based on issues resolved, helping standardize how the team works.
• Communicate efficiently and professionally with clients (practices and their staff) on escalated matters, representing the organization with a polished, credible, client-ready presence.
• Manage a high volume of concurrent tasks against productivity and completion-rate targets without sacrificing accuracy.

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Senior Revenue Cycle Specialist