Revenue Cycle Operations Specialist (Full-time; On-site required)

Pagosa Springs Medical Center•Pagosa Springs, CO

1d•$25 - $38•Onsite

About The Position

Pagosa Springs Medical Center (PSMC) is seeking an experienced and versatile Specialist III: Revenue Cycle Operations to join our Patient Financial Services team. This full-time, on-site position supports multiple Revenue Cycle functions to help ensure patient financial workflows are efficient, accurate, and compliant. The Specialist III serves as a flexible operational resource, providing departmental coverage, process improvement, reporting, training support, and assistance with special projects. The position also provides leadership to Revenue Cycle staff in the absence of managers and the Director. This is an excellent opportunity for an experienced revenue cycle professional who understands how the pieces of the revenue cycle fit together and enjoys solving problems, supporting coworkers, improving processes, and stepping into different areas based on operational needs.

Requirements

Minimum of three (3) years of healthcare revenue cycle experience required
Current AHA BLS (HeartSaver) certification required
Strong knowledge of CPT-4/HCPCS coding required
Strong working knowledge of Microsoft Office applications, particularly Excel, Outlook, Word, and Teams, as well as Access, data entry, and spreadsheets

Nice To Haves

Associate's degree in Healthcare Administration, Business Administration, Finance, or a related field preferred but not required
Experience across multiple Revenue Cycle functions strongly desired
Hospital, physician practice, or healthcare system Revenue Cycle experience strongly desired
Electronic health record experience, particularly Cerner, strongly desired

Responsibilities

Perform assigned revenue cycle functions based on operational needs and workload priorities
Provide coverage for vacancies, PTO, leaves of absence, and fluctuations in departmental volume
Coordinate daily revenue cycle activities including patient registration, scheduling, insurance verification, authorizations, charge capture, billing, collections, and payment posting
Assist with account resolution, claim follow-up, payment research, and work queue management
Cross-train throughout Revenue Cycle to effectively provide operational support where needed
Monitor accounts receivable work queues and ensure timely follow-up on unpaid, denied, and underpaid claims
Investigate and resolve claim edits, denials, and reimbursement discrepancies
Verify insurance coverage, benefits, and authorization requirements to support clean claim submission
Ensure accurate and timely claim submission in accordance with payer guidelines and regulatory requirements
Reconcile payments, adjustments, and contractual allowances to ensure account accuracy
Maintain accurate documentation of account activity, follow-up actions, and correspondence
Collaborate with providers, clinical staff, coding teams, and payers to resolve billing and reimbursement issues
Monitor scheduling and prior authorizations to help ensure patients are scheduled promptly and efficiently
Verify insurance benefits and authorization requirements
Assist with patient account inquiries
Provide billing support to patients and their families
Help resolve financial and insurance-related issues while providing professional, patient-centered service
Monitor key Revenue Cycle performance indicators and identify opportunities for improvement
Support month-end reporting, revenue reconciliation, and operational audits
Assist in developing and implementing workflow improvements that enhance efficiency and cash collections
Participate in quality assurance initiatives
Support special projects related to Revenue Cycle optimization
Use analytical and problem-solving skills to identify issues and recommend practical solutions
Train and support staff on Revenue Cycle procedures, payer updates, and system changes
Serve as a knowledgeable operational resource for Revenue Cycle staff
Collaborate with leadership and team members to maintain productivity and meet departmental priorities
Provide leadership to Revenue Cycle staff in the absence of managers and the Director
Promote a collaborative environment focused on learning, quality, accountability, and continuous improvement
Ensure compliance with HIPAA, Medicare, Medicaid, commercial payer requirements, and organizational policies
Support quality improvement activities to maintain departmental standards
Maintain strict confidentiality of patient and financial information
Help ensure Revenue Cycle processes remain accurate, timely, compliant, and patient-focused