Revenue Cycle Specialist

Texas Health Action•Austin, TX

1d•Hybrid

About The Position

The Revenue Cycle Specialist plays a foundational role in supporting Kind Clinic’s evolving revenue cycle function. This position is responsible for day-to-day revenue cycle operations, including claims management, insurance follow-up, denial resolution, accounts receivable management, and oversight of high-balance laboratory accounts. Kind Clinic’s revenue model is designed to support equitable access to care. The Revenue Cycle Specialist will ensure accurate insurance billing and reimbursement while coordinating closely with internal patient assistance programs to prevent avoidable financial harm to patients. This role emphasizes payer accountability, thoughtful resolution of coverage issues, and strong internal collaboration across Clinical Operations, Patient Support Services, and the Kind Patient Assistance Program (KPAP). As a newly established role within a growing revenue cycle structure, the Revenue Cycle Specialist will help refine workflows, assist in developing Standard Operating Procedures, and make recommendations to improve efficiency and compliance under the guidance of the Director of Revenue Cycle.

Requirements

Minimum 3 years of physician practice billing and revenue cycle experience.
Experience working denials, eligibility issues, and accounts receivable follow-up.
Strong understanding of ICD-10 diagnosis coding and payer coverage rules.
Familiarity with revenue cycle workflows and willingness to contribute to SOP development.
Strong analytical, organizational, and problem-solving skills.
Ability to work collaboratively across clinical, operational, and financial teams.
Ability to communicate effectively in person and virtually with staff and leadership.
Ability to work in a fast-paced environment with multiple priorities and stakeholders.

Nice To Haves

Coding certification (CPC, CCS-P, or similar) strongly preferred.
Experience with athenaOne/athenaCollector preferred.
Experience working with laboratory billing workflows (e.g., Quest Diagnostics) preferred.

Responsibilities

Execute Revenue Cycle production tasks, including but not limited to: claims submission, follow-up, payment, and denial management, ensuring accuracy, timeliness and compliance with payor requirements.
Perform eligibility, coverage, and payer discrepancy resolution for claims and balances, including issues related to date of service coverage, coordination of benefits, demographic inconsistencies, benefit limitations, and diagnosis-related coverage determinations.
Manage assigned work queues within athenaCollector, including claims on hold, resubmissions, follow-up, and aging review.
Research and resolve insurance denials related to eligibility, coverage at date of service, and payer processing errors.
Coordinate corrections with clinical or operational staff to obtain diagnosis clarification or updates.
Monitor unpaid or underpaid claims, ensuring timely and compliant follow-up.
Support accounts receivable management and contribute to denial category tracking and reporting.
Support the review of high-balance laboratory accounts from Quest Diagnostics.
Apply the same eligibility, coverage, and payer discrepancy resolution framework to laboratory balances, identifying root causes and appropriate resolution pathways.
Coordinate with clinical staff when diagnosis clarification or coding updates are warranted.
Collaborate with Quest billing representatives to resolve identified issues and facilitate claim reprocessing when applicable.
Identify and flag recurring trends in laboratory billing issues to support workflow improvements.
Identify balances eligible for internal financial assistance and coordinate transfer to the KPAP Program when appropriate.
Collaborate with Patient Support Services and the KPAP Program Manager to initiate transfers of eligible patient balances to the KPAP internal assistance program.
Ensure balances are appropriately routed when patients meet established financial eligibility criteria.
Maintain accurate documentation and tracking of transferred balances within revenue cycle workflows.
Support a patient-centered approach that balances fiscal responsibility with access to care.
Assist the Director of Revenue Cycle in developing and refining revenue cycle workflows and Standard Operating Procedures (SOPs).
Identify operational inefficiencies and recommend improvements.
Support periodic coding audits and internal compliance reviews.
Support the ongoing optimization of athenaCollector and related billing systems.
Assist in preparation of A/R aging reports, denial trend summaries, and laboratory balance analytics.
Collaborate with Clinical Operations, Health Information Management (HIM), Finance, and external partners to resolve revenue cycle issues.
Support implementation of new payers, billing configurations, or system enhancements as directed.