Revenue Cycle Claims Specialist-Client Billing - Remote

Position Summary:

The Revenue Cycle Claims Specialist will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes impacting cash collections.

Job Responsibilities:

• Serves as a source of knowledge for the designated revenue cycle function  
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
• Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.
• Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy.
• Develops, manages and monitors successful completion of implementation and project plans.
• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

Qualifications: 

• At least 3 years of experience in medical billing and Insurance collections
• At least 3 years …