Revenue Cycle Specialist

Revenue Cycle Specialist
This role ensures smooth and efficient patient billing experience while maintaining regulatory compliance and data integrity across healthcare systems.  The Revenue Cycle Specialist is responsible for overseeing the duties below but is not limited to the following:

Coordination of Benefits Review

- Generates weekly reports for assigned Coordination of benefits denial accounts.

- Communicates with patients via phone, letter mail out, email and text for requested COB information and action required.

- Follows up within a timely manner on all COB pending claims, ensuring final communication has been exhausted prior to patient balance transfers.

- Applies patient responsibility accordingly once confirming no patient compliance to COB update request.

- Ensures accurate posting classifications and patient account notes are clear and concise with action taken.

- Keeps track of trends and errors and communicates back to Lead and Management team.

- Meets deadlines and quotas per department needs.

Contracted Payor Invoicing

- Generate monthly invoice reports for assigned group(s) and preps monthly invoice to be delivered by the 15th of each month.

- Verify accuracy of billing data and revise any errors before submission.

- Ensure compliance with HIPAA regulations and billing standards.

- Stay up to date with changes in insurance and billing regulations.

- Generates monthly A/R for all invoiced accounts reaching 30 days for review of payment and/or expected payment date details.

- Stores invoices in Company SharePoint account and keeps invoice tracker up to date; maintain accurate patient billing records and documentation.

- Keeps open and professional communication with vendors.  Answer patient billing inquiries and resolve billing issues, including outstanding invoices pending payment, and any disputed charges.

- Work closely with RCM department and contracted 3rd party vendors.

- Keeps track of trends and errors and communications in monthly meetings.

Hospital Registration Auditing

- Conduct daily and/or weekly audits of ER front desk registration records and workflows to meet deadlines

- Review patient demographic data, insurance information, consent forms, and financial responsibility documentation for accuracy and completeness

- Identify and report registration errors or inconsistencies that may lead to claim denials or compliance risks

- Audit time-stamped workflows for timeliness in triage, registration, and insurance verification

- Track audit results, trends, and improvement metrics; escalate patterns to management

- Collaborate with the Patient Access, Revenue Cycle, and Compliance teams to refine registration policies

- Participate in root cause analysis of registration-related denials and recommend process improvements

- Maintain confidentiality of patient and organizational data at all times

Required Skills and Qualifications:

- High school diploma or equivalent required

- Associate degree or healthcare certification preferred

- 2+ Years previous experience in a healthcare or customer service setting strongly preferred

- Knowledge of medical terminology, insurance plans, and billing practices is a plus

- Proficiency in using electronic health records (EHR) and Microsoft Office

- Strong communication, interpersonal, and organizational skills

- Ability to multitask in a fast-paced environment and handle sensitive information with discretion

- Bilingual skills (preferred but not required)