Revenue Cycle Specialist I

Emory Healthcare•Tucker, GA

3d•Onsite

About The Position

The Revenue Cycle Specialist is responsible for managing all aspects of the revenue cycle, including the resolution of patient claims, ensuring accurate billing, and maximizing reimbursement. This role serves as a patient advocate, supports financial processes, and contributes to overall operational efficiency and quality improvement.

Requirements

Strong analytical and problem-solving abilities
Excellent verbal and written communication skills
Proficiency in EMR systems, payer systems, and financial tools
Ability to interpret and apply managed care contracts
Strong organizational and time management skills
Ability to work independently and collaboratively
Bachelor’s degree with two (2) years of relevant experience; OR Any equivalent combination of education and experience

Nice To Haves

Maintain knowledge of managed care contracts and apply terms to billing and reimbursement processes.
Understand billing requirements for specialized services, including: Transplants, Hospice, Infusions, Rehabilitation, Centers of Excellence
(If applicable) Maintain knowledge of transplant care standards and donor/recipient phases.

Responsibilities

Manage patient accounts across the full revenue cycle, ensuring timely resolution of all claims.
Verify, research, and complete required documentation to submit claims for reimbursement.
Analyze payments, identify variances, and resolve complex reimbursement issues.
Ensure compliance with payer requirements, including pre-certifications and claim splitting.
Maintain knowledge of managed care contracts and apply terms to billing and reimbursement processes.
Update and maintain accurate patient demographic and insurance information.
Communicate financial policies to patients clearly and effectively.
Identify patients needing financial counseling and provide appropriate resources.
Support patients during and after care with billing, collections, and financial assistance.
Serve as a patient advocate throughout the lifecycle of the account.
Collect and follow up on assigned accounts before, during, and after admission/discharge.
Perform account reconciliation and ensure timely reimbursement.
Resolve financial issues related to patient accounts using analytical and problem-solving skills.
Work closely with leadership to improve departmental workflows and processes.
Assist with departmental operations and workflow needs as required.
Serve as a resource and point of contact for staff questions.
Support training and development of new team members.
Identify issues impacting revenue and notify leadership with recommended solutions.
Contribute to quality assurance initiatives by reporting trends, denials, and improvement opportunities.
Participate in education sessions and insurance payer forums to stay current on industry standards.
Maintain working knowledge of insurance and reimbursement processes, referrals and authorizations, and Electronic Medical Records (EMRs) and financial systems.
Understand billing requirements for specialized services, including Transplants, Hospice, Infusions, Rehabilitation, and Centers of Excellence.
Operate effectively in a high-volume environment with heavy phone and computer usage.
Demonstrate professionalism, organization, and strong communication skills at all times.
Work independently while managing multiple priorities.
Perform additional duties as assigned.