Revenue Cycle Specialist

Overview

The Revenue Cycle Specialist is responsible for the company’s third-party medical claims processing and submission. The work completed by the revenue cycle specialist directly affects the collection of revenue for the organization. This role works within the computerized claims management system for the validation, submission, and processing of insurance and self-pay claims.

• Enters necessary information for insurance claims (e.g., patient demographics, insurance , diagnosis, treatment codes, modifiers, and provider information).
• Submits claims to clearinghouse or individual payers electronically or via paper CMS-1500 form or UB-04.
• Follows up with payers on unpaid or rejected claims via phone or website.
• Ensures claim information is accurate and complete.
• Resolves claim errors and resubmits for payment.
• Performs special projects as needed and assigned.
• Performs other duties as assigned.

• Required Qualifications: High School Diploma
• Minimum one (1) year experience in insurance, healthcare, or customer service field.
• Preferred Qualifications: Previous experience with healthcare billing, follow-up, and collections.