Revenue Cycle Specialist | BAR - BCBS

UF Health•Gainesville, FL

6d•Hybrid

About The Position

The Revenue Cycle Liaison plays a critical role in protecting and optimizing revenue by ensuring the integrity of physician coding and professional billing practices across UF Health and assigned departments. This position serves as a key resource for coding compliance, denial resolution, and reimbursement optimization through the review and analysis of ICD-10 and CPT coding, payer requirements, and institutional billing guidelines. Responsibilities include conducting detailed analyses of complex denials, identifying reimbursement trends, researching claim issues, interpreting managed care contracts, and reviewing reimbursement variances. The Revenue Cycle Liaison develops comprehensive appeals supported by coding expertise, medical documentation, clinical literature, and payer-specific guidelines to maximize appropriate reimbursement. Through collaboration with coding, billing, compliance, and operational teams, this role drives continuous process improvement, promotes regulatory compliance, and supports the overall financial health of the organization.

Requirements

High school diploma or equivalent required.
Two (2) years of experience in hospital and/or physician billing required.

Nice To Haves

Associate degree in Healthcare Administration, Business, Health Information Management, or a related field preferred.
An Associate degree may substitute for the required work experience.
Experience with healthcare revenue cycle processes, billing regulations, and reimbursement practices preferred.
Experience working with claim denials, appeals, reimbursement analysis, and payer guidelines preferred.
Experience using the Epic electronic health record (EHR) system preferred.
Knowledge of ICD-10, CPT, and healthcare billing and reimbursement practices preferred.
Ability to code both diagnoses and procedures preferred.
Ability to interpret payer policies, managed care contracts, and reimbursement methodologies.
Comfortable communicating with physicians, providers, and payers regarding diagnosis and procedure relationships, billing requirements, reimbursement variances, and coding concerns.
Ability to confidently and professionally advocate for coding and billing reviews, corrections, and process improvements.
Strong analytical, research, problem-solving, and organizational skills.
Proficiency with Microsoft Excel and healthcare-related software applications, such as EncoderPro or similar coding and reimbursement tools.
CPC, CCS, CCA, RHIT, RHIA, or other related coding certification preferred.

Responsibilities

Review and analyze physician coding and billing practices to ensure compliance with ICD-10, CPT, payer, and organizational guidelines.
Investigate and resolve complex claim denials, underpayments, and reimbursement variances.
Conduct detailed data analysis to identify denial trends, coding opportunities, and revenue cycle improvement initiatives.
Interpret managed care contracts and payer policies to support accurate reimbursement and appeals strategies.
Develop and submit comprehensive appeals, including coding rationale, clinical documentation, supporting literature, and payer-specific references.
Collaborate with providers, coding teams, billing staff, compliance, and operational leaders to address reimbursement and coding concerns.
Monitor and report on denial trends, reimbursement performance, and revenue cycle metrics.
Recommend process improvements to enhance coding accuracy, reduce denials, and improve financial outcomes.
Provide education and guidance regarding coding, documentation, billing requirements, and payer regulations.
Support compliance efforts by ensuring claim submission practices align with regulatory and institutional standards.
Research payer policies, reimbursement methodologies, and regulatory updates to maintain subject matter expertise.
Serve as a liaison between clinical, coding, billing, and payer stakeholders to facilitate issue resolution and revenue recovery.