Revenue Cycle Specialist

Advanced Radiology Consultants•Shelton, CT

About The Position

Advanced Radiology is one of the largest independent radiology practices in the tri-state area with the most experienced radiologists. We look for team members who want to grow and be professionally challenged, while enjoying a rewarding, caring, and friendly environment. We are looking for a Revenue Cycle Specialist to join our team. The pay range for this role will depend on experience and qualifications. Under the direction of the Senior Revenue Cycle Manager, this role is responsible for expediting claim processing by coordinating with the outside billing company to ensure timely submission and resolution of initial claims and denials. Duties include conducting chart reviews for CPT and ICD‑10 clarification, performing denial follow‑up, and completing monthly reconciliations of procedures performed versus billed. The position also supports additional A/R follow‑up activities, assists with patient dispute resolution, and reviews A/R reports to identify trends, patterns, and operational issues.

Requirements

Attention to detail, meticulously reviewing reports, charts and assigning codes with a high degree of accuracy is critical to assign accurate CPT, ICD-10, HCPCS & modifiers
Knowledge of medical terminology
Understanding of insurance carrier claim processing, rules and regulations to include payment, denial and appeal processes, authorization requirements and guidelines.
Ability to multi-task yet remain focused.
Proficient with automated radiology information systems including billing component.
Ability to handle escalated patient issues
High school diploma or general education degree (GED)
5+ years’ experience in healthcare billing/collections, preferably radiology or a combination of education and experience.

Nice To Haves

CPC and/or RCC certification preferred.
Bi-Lingual helpful though not required.

Responsibilities

Review/resolve billing company’s Request for Additional Information’ (RAI’s), including; CPT/ICD-10 review and/or confirmation prior to billing
Denials management: Coding denials: evaluate for correction, resubmission, or adjustment Authorization denials: investigate, resolve, and coordinate with appropriate department for updates or correction Miscellaneous denials: review and determine appropriate resolution Patient disputes: investigate coding accuracy, clinical information, claim activity and the basis of the patient’s concern; resolve when applicable.
Support the Senior Revenue Cycle Manager in educating providers and staff on CPT, ICD-10, carrier guidelines, and billing requirements for examinations performed
Handle escalated billing calls and web inquiries, providing professional, customer-focused resolution and assisting ADRAD staff and patients with complex coding or insurance questions.
Review of A/R denials, categorize issues, and collaborate with billing company to drive timely claim resolution
Perform monthly charge reconciliation to ensure all procedures performed are accurately billed
Conduct monthly reviews of outstanding A/R, including: Identifying denial trends, coding issues, and operations patterns Flagging mishandled claims for review with Senior Manager to support staff education and process improvement for both ADRAD and billing company
Monitor insurance carrier, State and Federal resources (publications/websites) for administrative and/or medical policy changes; prepare monthly summaries and review with the manager for staff education when applicable
Other Revenue Cycle tasks assigned, as needed
Provide assistance to other Revenue Cycle departments as needed