Revenue Cycle Specialist

Vanova Health • Verona, NJ

1d • $26 - $27 • Hybrid

About The Position

The Revenue Cycle Specialist is responsible for the end-to-end management of professional billing functions, including charge review, claim submission, payer follow-up, payment posting, and patient account resolution. This role requires strong working knowledge of modern revenue cycle technology, payer portals, and regulatory requirements to ensure accurate, timely reimbursement and a positive patient financial experience.

Requirements

• 2–5+ years of experience in medical billing, accounts receivable, or revenue cycle operations.
• Strong understanding of CPT, ICD-10, and payer reimbursement methodologies.
• Practice Management/EHR systems (e.g., athenaOne or similar).
• Payer portals (e.g., Availity Essentials, NaviNet, UHC/Optum, BCBS portals).
• Clearinghouses and ERA/835 processing tools.
• Microsoft Excel and reporting tools for A/R and payment analysis.
• Experience working with commercial payers, Medicare, and Medicaid.
• Hands-on experience with payer portals and electronic claim management tools.
• Familiarity with denial management, appeals, and contract reimbursement validation.
• High attention to detail with strong analytical and problem-solving skills.
• Ability to manage workload independently in a hybrid work environment.
• Adhere to all HIPAA, OSHA, and compliance regulations.
• High ethical standards and ability to maintain confidentiality.
• Follow all internal policies and payer billing guidelines.

Nice To Haves

• Experience in multi-specialty or primary care environments.
• Exposure to AI-assisted coding or automation tools (e.g., claim scrubbing or auto-coding platforms).
• Knowledge of value-based care models and payer-specific nuances.

Responsibilities

• Review and validate provider charges in the practice management system for accuracy, completeness, and compliance prior to claim submission.
• Perform claim scrubbing and ensure clean claim submission through systems such as athenaOne or equivalent platforms.
• Submit and monitor claims through clearinghouses and payer portals including Availity Essentials, NaviNet, and payer-specific websites.
• Conduct insurance follow-up on outstanding claims using A/R aging reports, payer portals, and direct payer outreach.
• Identify, research, and resolve claim denials; initiate and track appeals as needed.
• Post payments (insurance and patient) accurately by line item, including reconciliation of EOBs/ERAs.
• Utilize electronic remittance advice (ERA) and 835 files to ensure efficient payment posting and denial identification.
• Review zero-pay and underpaid claims to ensure reimbursement aligns with contracted rates.
• Follow up on patient balances, including outbound calls and portal communication, while maintaining a high level of customer service.
• Process refunds in accordance with payer policies and compliance guidelines.
• Verify patient demographics and insurance eligibility at the time of billing to prevent downstream denials.
• Maintain familiarity with payer policies, reimbursement rules, and billing guidelines, including Medicare and Medicaid requirements.
• Communicate billing trends, payer issues, and workflow gaps to management for process improvement.
• Support front desk and clinical teams with billing-related education and feedback to improve clean claim rates.

Benefits

• Comprehensive benefits based on eligibility include a 401K retirement savings plan with company match, paid time off, and health benefits (medical, prescription drug, dental and vision insurance).
• This position offers an opportunity for annual target bonus based on individual performance and company financial performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed