Revenue Cycle Specialist II

About This Role

This role is vital for managing the revenue cycle, ensuring healthcare providers receive appropriate payment by correcting billing errors and addressing claim denials in accordance with payer guidelines. It focuses on protecting revenue and enhancing efficiency within the healthcare billing process.

Responsibilities

• Review and analyze unpaid and denied insurance claims to determine root causes and identify corrective action
• Research and interpret payer policies, contracts, coverage determinations, and clinical guidelines to support claim corrections and appeal strategies
• Prepare, submit, and track appeals, reconsiderations, and corrected claims in a timely and accurate manner
• Communicate directly with insurance carriers via phone, payer portals, and written correspondence to clarify denial reasons, obtain claim status updates, and advocate for appropriate reimbursement
• Collaborate closely with coding, billing, and clinical teams to obtain, review, and submit supporting medical documentation
• Maintain thorough and accurate documentation of all denial resolutions, appeal submissions, payer communications, and outcomes
• Monitor claims filing and deadlines, payer response timelines, and follow-up requirements for compliance
• Identify recurring denial trends and systemic issues, analyze their financial and operational impact, and escalate findings to leadership with recommendations
• Assist with denial prevention initiatives by providing feedback, education, and workflow recommendations
• Stay current on federal and state regulations, CMS guidelines, and individual insurance company policies

Requirements

• 5-10 years in medical billing and claim denial management
• Strong proficiency in Microsoft 365 (Outlook, Word, Excel, Teams, etc.)
• Working knowledge of payer regulations and hospital billing processes
• Familiarity with CPT, ICD-10, and HCPCS coding concepts
• Experience using electronic health record (EHR) and/or medical billing software
• Excellent verbal and written communication skills
• Exceptionally proactive, organized, and detail oriented

Qualifications

• 5-10 years in medical billing and claim denial management

Skills

* Required skills