Revenue Cycle Specialist

• Oversee revenue cycle processes including charge entry, billing, claims, patient accounts receivable, and insurance accounts receivable
• Verify claim information before billing
• Review surgical coding for accuracy before billing
• Process primary, secondary, and tertiary claims and address edits or rejections
• Post patient, insurance, and third-party payments
• Resolve insurance and self-pay credits
• Process bad debt
• Answer phones
• Complete assigned duties and assist others as directed
• Follow policies introduced during onboarding, updated in real time, and outlined in the Teammate Handbook

Remote Revenue Cycle Specialist processing medical claims and payments for a healthcare provider

Remote Revenue Cycle Specialist processing medical claims, coding, payments, and accounts receivable. Supporting billing operations for a healthcare provider while maintaining HIPAA compliance.

• Prepare and submit provider enrollment and credentialing applications to Florida Medicaid and Managed Care Organizations
• Monitor and track application statuses through final approval
• Organize and maintain credentialing files, payer contracts, and official documentation
• Coordinate re-credentialing processes before expiration deadlines
• Oversee daily electronic claims submissions and verify accuracy
• Research, correct, and resubmit rejected claims and draft appeals
• Monitor unpaid claims and communicate with insurance representatives
• Post payments and process claim corrections in the billing system
• Track accounts receivable to reduce outstanding balances and improve collection rates
• Prepare monthly billing and financial reports for management
• Maintain HIPAA compliance and follow payer and state guidelines
• Assist management and external auditors during administrative or financial reviews
• Complete onboarding, learn HomeWell workflows, and audit current Medicaid/payer enrollments
• Clear pending credentialing applications and independently manage the billing cycle
• Own billing and credentialing processes while reducing claim denials

Revenue cycle specialist managing Florida healthcare billing and provider credentialing for an in-home care franchise

Revenue Cycle, Credentialing Specialist

Revenue cycle specialist managing Florida Medicaid credentialing, claims, billing, and reimbursement. Supporting HomeWell’s in-home senior care operations through compliant revenue-cycle oversight.

• Performs extensive follow-up to investigate and resolve payment denial trends.
• Assists with the development and implementation of strategies and procedures that will reduce denials, maximize reimbursements and promote faster payment.
• Utilizes the practice management system to sort, filter, summarize and identify various account receivable trends to solicit payments from insurance companies and patients.
• Prepares letters of appeal to insurance carriers for claims that were not paid or paid at the incorrect rate.
• Resolves claim edits within the practice management billing system to ensure successful claim submission.
• Assists in training current and new employees on the use of systems and departmental policies and procedures.
• Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
• Reviews and submits refund and write-off requests.
• Approves and performs write-offs as requested and as necessary.
• Performs other related duties as assigned.

Revenue Cycle Specialist handling payment denials and trends.

Revenue Cycle Specialist – A/R

Revenue Cycle Specialist managing AR follow-up for payment denials. Investigating trends and collaborating with teams to enhance service revenue.

• Support claim submission to ensure timely, accurate billing
• Monitor claim status and follow up on unpaid or denied claims
• Assist with provider credentialing and payer enrollment, keeping documentation and records current
• Manage accounts receivable, including aging follow-up, collections, and resolution of outstanding balances
• Support denial management by identifying issues, documenting trends, and escalating complex cases
• Post payments, adjustments, and remittance information accurately
• Reconcile billing discrepancies and resolve account issues
• Verify patient eligibility, insurance information, and benefits as part of the insurance workflow
• Maintain documentation of billing activity, follow-up efforts, and account status
• Communicate with payers, vendors, and internal teams on claim issues and payment delays
• Help track key RCM metrics such as clean claim rate, denials, days in A/R, and collections
• Support process improvement efforts to increase efficiency and reduce billing errors
• Ensure all work complies with company policies and applicable healthcare regulations

Junior RCM Specialist supporting revenue cycle management for a virtual healthcare practice

Junior Revenue Cycle Management, RCM Specialist

Junior RCM Specialist supporting the full revenue cycle for a virtual healthcare practice. Involves billing, claims processing, and accounts receivable management in a remote setting.

• Entry level position responsible for submitting and resolving medical claims of low to moderate complexity.
• Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.
• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Contacts patients and guarantors to secure necessary billing information.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Performs other related duties as assigned.

Entry level position resolving medical claims in a hybrid work environment

Revenue Cycle Specialist I

Entry level position resolving medical claims in a hybrid environment while ensuring compliance with billing standards. Contributing to accurate claim resolution for both inpatient and outpatient services.

• Provide high-quality radiology services to hospitals and healthcare facilities
• Collaborate with physicians and healthcare teams to ensure patient care
• Contribute to innovative clinical practices and technology

Radiology specialist providing services to healthcare facilities across the U.S.

Radiology specialist at Radiology Partners providing high-quality services to healthcare facilities in the U.S. Collaborating with healthcare teams to enhance patient care and innovate clinical practices.

• Revenue and Reimbursement Management
• Insures the appropriate bundling or unbundling of charges so that all charges are submitted result in maximum reimbursement while following applicable billing, coding and reimbursement regulations.
• Interprets Medicare transmittals to determine whether new codes, coding changes, or directives that alter billing and compliance are required and to communicate these changes to all relevant departments.
• Proactively identifies new charge opportunities and makes monthly recommendations to prevent future billing problems.
• Manages the process of CDM maintenance including the training and supervision of staff in order to process CDM request in a timely response to decrease bill rejections and payment delays due to chargemaster driven coding and charging issues.
• Effectively utilizes all internal automation and software applications. Prepares reports as required by management regarding process improvement recommendations and systematic claim processing issues.
• Answers questions regarding hospital and departmental operations, policies and procedures.
• Assist Payer Relations with contract analysis to receive maximum reimbursement.
• Develop or modify revenue and reimbursement reports to prevent a disruption in the revenue stream.
• Quality
• Safeguards the hospital against exposure to denials, penalties and fines by ensuring healthcare services are billed accurately and properly at all times.
• Coordinates and performs the analysis of the yearly charge change recommendations and pricing schedule changes recommended by the contracted Revenue Consultants.
• Collaboration and Partnership
• Assists the billing personnel in resolving third party payor billing problems and works to streamline the revenue cycle in coordination with Department Managers, Business Office, HIM and Managed Care to increase charge capture, receive accurate payments from payers and minimize claim denials.
• Assists departments in coordinating, compiling and interpreting information regarding health care services and operating costs in an effort to create efficient charging practices and the capture of appropriate revenue.
• Performs in-house education regarding revenue cycle/indicators for Department Managers.
• Other Duties As Assigned
• Performs other duties as assigned or requested.

Chargemaster Revenue Cycle Specialist overseeing hospital departmental chargemasters

Chargemaster Revenue Cycle Specialist

Chargemaster Revenue Cycle Specialist responsible for monitoring hospital chargemasters and improving revenue cycle efficiency. Ensures compliance with billing regulations and manages CDM processes.

• Submits monthly claims and invoices along with discharge claims within two business days of creation.
• Reviews Payor Aging and works accounts accordingly for multiple sites within a Central Business Office Environment.
• Ensures accurate, complete, and timely account follow-up. Documents accounts within Perimeter guidelines.
• Resolves claim processing issues in a timely manner, escalates problem claims to their supervisor.
• Resolves credit balances in a timely manner.
• Reviews Remittance Advices daily and prioritizes Zero Pay accounts for immediate resolution.
• Works directly with Payor Plans/Funding Sources to resolve ongoing issues.
• Communicates Payor updates to Revenue Cycle Leadership in a timely manner.
• Reviews Facility Correspondence in a timely manner.
• Reviews new Admissions for Payor Plan accuracy.
• Prepares write-off requests based on review of balances, and submits to leadership for review and approval
• Reviews Denial Log and coordinates Denial write-offs with Facility UM Director.
• Familiar with billing requirements for payor plans...not limited to Medicaid and Medicare.

Revenue Cycle Specialist managing billing for behavioral health services

Revenue Cycle Specialist managing billing and claims for behavioral health services remotely. Ensuring accurate claims submission and resolution of payer issues within established timelines.

• A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Yield Management Division.
• This department may work directly with other members of Yield to ensure department expectations are accomplished.
• The Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and/or daily functions and processes that are necessary for business execution.
• Other responsibilities will include solving complex issues that have been identified and being a point person for other Revenue Cycle Specialists within the department.
• Analyzes, identifies, and implements procedural change opportunities to improve performance and efficiency, and maximize revenue or margins.
• Works with manager to establish an implementation plan and can work independently or with support of Specialists to implement plan.

Senior Revenue Cycle Specialist managing complex financial functions and processes

Senior Revenue Cycle Specialist

Senior Revenue Cycle Specialist in Yield Management Division overseeing financial processes and collaborating across teams to enhance revenue cycle efficiency.

• Full claims lifecycle for outpatient behavioral health services across commercial, Medicare, and Medicaid managed care payers
• Denials management: root-cause analysis, appeals, resubmissions, payer follow-up, and prevention
• AR aging triage, payer follow-up strategy, and escalation of recurring issues
• ERA/EOB posting and reconciliation against expected contracted rates
• Investigation of underpayments, rate anomalies, ERA disruptions, and recurring denial patterns
• Written process documentation for the revenue cycle lane
• Clear communication with the Practice Manager when a payer issue needs leadership attention

Senior Medical Biller managing outpatient claims at Seasons Psychotherapy Associates

Senior Medical Biller / Revenue Cycle Specialist

Senior Medical Biller managing full claims lifecycle for outpatient behavioral health services at Seasons Psychotherapy Associates. Handling denials, AR follow-up, and reporting to Practice Manager.

Senior Medical Biller managing claims pipeline for outpatient behavioral health services

Senior Medical Biller managing claims pipeline for outpatient behavioral health services across commercial, Medicare, and Medicaid payers. Focusing on denials management, AR follow-up, and process documentation in a hybrid role.

• Submit accurate claims for infusion therapies, injectable medications, and physician-administered drugs to insurance payers
• Track claims to ensure timely processing and reimbursement
• Identify and address claim rejections and denials promptly
• Reconcile payments and outstanding balances for infusion and injectable drug claims
• Maintain detailed records of payer communications and payment status
• Confirm insurance eligibility and coverage for infusion therapies and physician-administered drugs
• Collaborate with pharmacy and clinical teams to obtain prior authorizations when required
• Ensure claims comply with payer policies, coding standards, and regulations
• Maintain organized and accurate documentation for audit purposes
• Identify opportunities to optimize the infusion and medical benefit drug billing process

Infusion and Specialty Drug Revenue Cycle Specialist managing accounts receivable processes

Infusion and Specialty Drug Revenue Cycle Specialist

Infusion and Specialty Drug Revenue Cycle Specialist managing accounts receivable processes related to physician-administered drugs. Collaborating with pharmacy teams and insurance companies for efficient revenue cycle management.

• The Revenue Cycle Specialist is responsible for reviewing and processing claims in various stages of the revenue cycle in a timely and compliant manner
• Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients
• Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues
• Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications
• Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner
• Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved
• Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though
• Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved
• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness
• Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs.

Revenue Cycle Specialist responsible for processing health insurance claims

Revenue Cycle Specialist reviewing and processing health insurance claims for optimal reimbursement. Collaborating with operational teams to ensure compliance and maximize client performance.

• Position responsible for submitting and resolving medical claims moderate to high complexity.
• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follow department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
• Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Meets and exceeds team productivity and quality standards.
• Takes the lead on special projects.
• Participates in staff training.
• Reviews complex claims issues for resolution and recommends process improvements.
• Performs other related duties as assigned.

Responsible for resolving medical claims in a fast-paced environment

Revenue Cycle Specialist II, Credit Management

Responsible for submitting and resolving medical claims. Must handle both inpatient and outpatient claims for compliance in a fast-paced medical environment.

• Provides billing support to Patient Financial Services.
• Performs payment posting to support revenue cycle operations.
• Identifies denials for follow up and performs account follow up activities.
• Updates information on accounts and organizes work in a timely manner.
• Participates in department meetings and provides feedback to management.

Revenue Cycle Specialist I supporting billing operations

Revenue Cycle Specialist I, Cash Management

Revenue Cycle Specialist I providing billing support in Patient Financial Services. Handling payment posting and account follow up in a healthcare organization.

• Performs retrospective coding review of denied charges for physician services.
• Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
• Make corrections to charges when necessary.
• Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation.
• Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals.
• Ensures denial reviews are conducted in a timely manner.
• Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
• Participates in annual and on-going mandatory compliance training.
• Fulfills Continuing Education Units necessary to maintain certification status.
• Assists in training current and new employees on the use of systems and departmental policies and procedures.
• Performs other related duties as assigned.

Revenue Cycle Specialist managing coding and insurance payment denials

Revenue Cycle Specialist – Revenue Integrity, Pathology

Revenue Cycle Specialist at Weill Cornell Medicine resolving coding-related insurance payment denials. Reviewing medical records and conducting coding reviews with compliance training.

• Responsible for processing, reviewing, and filing insurance to the resolution of the claim payment.
• Assist patients with billing questions and the collection of patient balances.
• Perform various functions in the processing of insurance billing and collections, including Medicaid/Medicare claims according to the established policies and procedures.
• Collect and enter patient's insurance information into ACS Compumed System.
• Review, verify, and submit insurance claims.
• Process correspondence from Third Party Payors and respond to patient requests.
• Follow up with insurance companies and ensure claims are paid in a timely manner.
• Resubmit insurance claims that have received no response.
• Answer telephones and provide/obtain information to resolve billing and collection issues.
• Maintain supporting billing information for future reference or audit purposes.

Revenue Cycle Specialist processing insurance claims for healthcare clients

Revenue Cycle Specialist processing insurance claims for healthcare providers. Assisting patients with billing questions while ensuring timely claim payments based on established policies.

• Review and work assigned accounts to resolve denied, underpaid, and unpaid insurance claims.
• Analyze payer responses, remittance advice, and denial codes to determine the appropriate resolution.
• Correct and rebill claims as needed to ensure accurate claim submission.
• Prepare and submit appeals for underpayments and erroneous denials with appropriate supporting documentation.
• Contact insurance carriers to obtain claim status, clarify denials, and facilitate payment.
• Document all account activity, payer communications, and follow-up actions in the billing system.
• Monitor accounts to ensure timely follow-up and resolution within established productivity standards.
• Identify payer trends and recurring billing issues and communicate findings to management.
• Collaborate with internal departments to resolve claim edits, coding, registration, or documentation issues affecting reimbursement.
• Maintain knowledge of payer policies, reimbursement guidelines, and applicable regulations.
• Meet productivity and quality goals while maintaining a high level of accuracy and attention to detail.
• Perform other revenue cycle duties as assigned.

Revenue Cycle Specialist managing accounts for insurance claim resolution

Revenue Cycle Specialist managing accounts for insurance claim resolution. Collaborating with internal teams and payers to ensure timely and accurate claim processing.

Revenue Cycle Specialist jobs in United States

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Revenue Cycle Specialist

Revenue Cycle, Credentialing Specialist

Revenue Cycle Specialist – A/R

Junior Revenue Cycle Management, RCM Specialist

Revenue Cycle Specialist I

Revenue Cycle Specialist

Chargemaster Revenue Cycle Specialist

Revenue Cycle Specialist

Senior Revenue Cycle Specialist

Senior Medical Biller / Revenue Cycle Specialist

Senior Medical Biller / Revenue Cycle Specialist

Infusion and Specialty Drug Revenue Cycle Specialist

Revenue Cycle Specialist

Revenue Cycle Specialist II, Credit Management

Revenue Cycle Specialist I, Cash Management

Revenue Cycle Specialist – Revenue Integrity, Pathology

Revenue Cycle Specialist

Revenue Cycle Specialist