Revenue Cycle Specialist - TGH Access Operations

Tampa General Hospital • Tampa, FL

4d

About The Position

The Revenue Cycle Specialist supports oncology practices by managing daily revenue cycle functions to ensure accurate billing, timely reimbursement, and regulatory compliance. The role handles front-end and back-end activities, including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial follow-up. It evaluates patients’ financial situations and insurance coverage, explains financial responsibilities, and helps patients access financial assistance and external resources.

The position maintains accurate billing logs, reimbursement references, payer-specific guidelines, patient tracking systems, and financial reporting tools. It reviews documentation requests, resolves charge rejections and denials, and coordinates with billing offices and claims teams to support timely claim submission and resubmission. The specialist also serves as a resource on oncology reimbursement requirements, revenue cycle processes, and compliance standards, and contributes to process improvements that enhance efficiency and reduce financial and legal risk.

Requirements

• Associate’s degree in business, finance, accounting, or a related field, or an equivalent combination of education or certification and demonstrated competencies.
• A minimum of 2–3 years of experience working within a medical billing department.
• Ability to manage front-end and back-end revenue cycle processes, including insurance verification, charge capture, billing, payment posting, and denial resolution.
• Skill in confirming coverage, analyzing benefits, and ensuring financial clearance.
• Strong knowledge of CPT, HCPCS, and ICD-10 coding systems and their application in oncology services.
• Knowledge of payer-specific authorization and medical necessity requirements.
• In-depth knowledge of state and federal healthcare regulations, including CMS, Medicare, Medicaid, and commercial insurance compliance standards.
• Knowledge of authorization processes, medical necessity criteria, and reimbursement guidelines.
• Ability to analyze, resolve, and prevent claim denials and rejections.
• Skill in explaining financial responsibilities and assisting with financial assistance programs.
• Competence in reviewing referrals, diagnosis codes, and procedure codes for accurate billing.
• Ability to develop and maintain patient tracking systems and financial reporting tools.

Responsibilities

• Oversee front-end and back-end processes, including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial resolution.
• Maintain adherence to state and federal healthcare regulations, including CMS, Medicare, and Medicaid requirements, and payer-specific guidelines.
• Confirm patient coverage, analyze benefits, and secure authorizations to support accurate billing and timely reimbursement.
• Communicate cost estimates, explain co-pays and deductibles, and assist patients in accessing financial assistance programs.
• Validate referrals, diagnosis codes, and procedure codes; resolve charge rejections and coordinate with billing teams for timely claim submission.
• Investigate and correct claim denials and rejections, ensuring resubmission within payer timelines.
• Develop and update patient tracking systems, billing logs, and financial reporting tools.
• Serve as a resource on oncology reimbursement requirements, compliance standards, and revenue cycle best practices.
• Identify opportunities to improve workflow efficiency, reduce errors, and optimize reimbursement outcomes.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree