Revenue Cycle Management Specialist

Centerpoint Health•Franklin, OH

1d•Hybrid

About The Position

Centerpoint Health is a FQHC seeking a Revenue Cycle Management Specialist for our community health center. We have locations in Franklin and Middletown, OH. We provide services in primary health care, ob-gyn, and behavioral health. Job Function: The Revenue Cycle Management (RCM) Specialist supports the financial health of Centerpoint Health by performing day‑to‑day aspects of the revenue cycle, including insurance eligibility, claims processing, payment posting, accounts receivable activities, patient account management, and assists with credentialing and enrollment for all payors. This role ensures accurate and timely reimbursement, resolves claim issues, communicates with payers and patients, and maintains compliance with all billing guidelines.

Requirements

Working knowledge of medical insurance, claim workflows, and reimbursement processes.
Understanding of ICD-10,CPT, and HCPCS coding conventions.
Strong attention to detail and organizational abilities.
Effective communication and customer service skills.
Ability to analyze account issues and follow through to resolution.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
High School diploma required.
1-3 years of experience in medical billing, revenue cycle operations, or related field.
The employee is required to understand the privacy policies and procedures.
Patient Health Information (PHI) is confidential, only the minimal amount of PHI necessary to accomplish the internal purpose is to be shared or released.
This position is contingent upon a successful background check, health requirements and drug test.

Responsibilities

Billing & Claims Processing Prepare, review, and submit clean claims to insurance payers.
Ensure accurate use of ICD‑10, CPT, and HCPCS codes.
Identify and correct claim errors or missing documentation.
Monitor claim status and follow up on outstanding or rejected claims.
Payment Posting & Account Updates Post insurance and patient payments, adjustments, and denials.
Reconcile daily payment activity to ensure accuracy.
Investigate payment variances and request corrections when needed.
Denial Resolution & A/R Support Review denial codes, explain root causes, and take action to resolve issues.
Prepare and submit appeals with required documentation.
Follow up on aging accounts to support timely collections.
Insurance Verification & Patient Support Verify insurance eligibility, coverage, and authorization requirements.
Communicate patient responsibility amounts clearly and professionally.
Respond to patient billing inquiries and assist with account clarification.
Compliance & Data Accuracy Maintain patient confidentiality and adhere to HIPAA and payer regulations.
Keep up to date with billing rules, reimbursement policies, and payer requirements.
Ensure accuracy and integrity of revenue cycle documentation and data.
Reporting & Workflow Support Generate basic reports related to billing, payments, denials, and A/R status.
Identify workflow issues and suggest improvements to increase efficiency.
Support audits by providing required documents and account information.
Perform other tasks and duties as assigned by the supervisor.