Revenue Cycle Specialist - TGH Access Operations

Tampa General Hospital•Tampa, FL

About The Position

The Revenue Cycle Specialist supports oncology practices by managing day-to-day revenue cycle functions to ensure accurate billing, timely reimbursement, and regulatory compliance. The role performs 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 specialist maintains accurate billing logs, reimbursement references, and payer-specific guidelines in accordance with state and federal regulations. The role reviews documentation requests, resolves charge rejections and denials, and coordinates with billing offices and claims teams to support timely claim submission and resubmission. It also develops and maintains patient tracking and financial reporting tools, serves as a resource for oncology reimbursement and compliance, and contributes to process improvements that enhance efficiency and minimize financial and legal risk.

Requirements

Associate’s degree in Business, Finance, Accounting, or a related field.
A minimum of 2–3 years of experience working within a medical billing department.
An equivalent combination of education or certification and demonstrated competencies may substitute for the required education.
Ability to manage front-end and back-end revenue cycle processes, including insurance verification, charge capture, billing, payment posting, and denial resolution.
Knowledge of medical coding systems, including CPT, HCPCS, and ICD-10, and their application in oncology services.
Knowledge of payer-specific authorization and medical necessity requirements.
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.
Ability to explain financial responsibilities and assist 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 revenue cycle 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, as well as payer-specific guidelines.
Confirm patient coverage, analyze benefits, and secure authorizations to support accurate billing and timely reimbursement.
Communicate cost estimates and explain co-pays and deductibles; assist patients in accessing financial assistance programs.
Validate referrals, diagnosis codes, and procedure codes; resolve charge rejections and coordinate timely claim submission with billing teams.
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 for 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.