Revenue Cycle Specialist

Community Hospice & Palliative Care•Jacksonville, FL

8d•Onsite

About The Position

The Revenue Cycle Specialist is responsible for the full in-house revenue cycle workflow for Community Palliative Care (CPC), including payment posting, adjustments, claims denial resolution, appeals, and claims reprocessing within eClinicalWorks (ECW). This role works under the direction of the Palliative Care RCM Manager and alongside the Palliative Care RCM Claims Specialist to ensure accurate, timely, and compliant billing and collections for the Palliative Care lines of business. This position reflects the transition of Palliative Care RCM functions from outsourced (Insync) management to a fully in-house team operating within ECW.

Requirements

Minimum of three (3) years of experience in medical billing, payment posting, and/or claims/denials management in an institutional or facility healthcare setting.
High School Diploma, minimum
Experience with electronic medical record (EMR) and practice management systems; eClinicalWorks (ECW) experience strongly preferred.
Experience working with Medicare, Medicaid, and commercial payers, including ERA/EOB payment posting and the appeals process.

Nice To Haves

Hospice or palliative care billing experience preferred.
Medical billing software, electronic medical records, and payment posting workflows.
Insurance verification, authorization requirements, and the claims appeals process.
Insurance reimbursement guidelines, including HMO/PPO, Medicare, Medicaid, and other payer requirements.
Revenue cycle operations and how billing, payment posting, denials, and collections functions work together.

Responsibilities

Post all payments — including electronic remittance advices (ERAs), explanations of benefits (EOBs), lockbox/check deposits, and patient payments — accurately and timely within ECW.
Apply contractual adjustments, write-offs, refunds, and other account adjustments in accordance with payer contracts, company policy, and Reasonable and Customary rate guidelines.
Reconcile daily and monthly payment batches to bank deposits and ECW ledgers to ensure accurate cash application.
Identify and resolve unapplied cash, overpayments, and posting discrepancies in a timely manner.
Review the daily claims/denial work queue and aging reports within ECW to identify, research, and resolve denied or rejected claims.
Correct and resubmit denied claims, including verifying and updating patient demographic and insurance eligibility information as needed.
Prepare, draft, and submit written appeals to Medicare, Medicaid, and commercial payers with all required supporting documentation, tracking appeal status through resolution.
Reprocess and rebill claims following payer correction, appeal outcomes, or system-identified errors.
Track and trend recurring denial and payment issues identified through ERAs to drive root-cause resolution and prevent repeat denials.
Open, review, and distribute incoming Palliative Care mail, including checks for deposit.
Pull and review updated face sheets from hospital/facility EMR systems to keep patient data current for claims correction.
Respond to internal requests for follow-up or documentation (e.g., from the Palliative Care RCM Manager, Compliance, or Finance) within no more than five (5) business days.
Maintain organized documentation of payer correspondence, EOBs, appeal letters, and payer newsletters in accordance with department recordkeeping standards.
Coordinate with the Palliative Care RCM Manager and Claims Specialist on payer, provider contract, and system issues.
Serve as a resource on denial resolution, payment posting, and claims correction processes for the RCM team.
Respond to patient billing inquiries, including statement questions, disputes, and overdue payment calls, in accordance with company collections and refund policy.
Maintain and troubleshoot access to payer websites/portals as needed to support claims and payment functions.
Attend and actively participate in regular RCM team meetings to discuss financial reports, aging, and billing-related issues.
Complete all required RCM and compliance training.
Comply with all applicable federal and state laws and regulations, as well as Alivia Care contractual agreements, related to the submission and processing of claims for palliative care services.
Serve as backup for other Palliative Care RCM functions as assigned.
Complete special projects and other duties as assigned by management.