Revenue Cycle Specialist

Easterseals Bluegrass•Lexington, KY

About The Position

The Revenue Cycle Specialist is responsible for the accurate and timely submission of claims across the programs and services provided by Easterseals Bluegrass, and for the resolution of denied and unpaid claims for the Prescribed Pediatric Extended Care (PPEC) program. This role consolidates claim submission activity currently distributed across program and administrative staff, establishing a single point of accountability within the Finance department for claim accuracy and reimbursement follow-through. Reporting to the Chief Financial Officer, the Revenue Cycle Specialist reviews service documentation, verifies eligibility, authorization status, coding, and modifier requirements prior to submission, and works claims through adjudication to payment. This position supports financial sustainability by increasing first-pass claim accuracy, reducing preventable denials, and shortening the time between service delivery and reimbursement.

Requirements

High school diploma or equivalent
Minimum of 2 years of experience in medical, healthcare, or human services billing, including claim submission and denials
Working knowledge of Medicaid or managed care claim adjudication, remittance advices, and appeal processes
Demonstrated ability to learn and work across more than one billing or practice management system
Experience with billing or accounting software and Excel
Strong attention to detail and the ability to work a claim queue independently
Commitment to the mission of Easterseals and to ethical financial practices

Nice To Haves

Associate’s degree in Accounting, Healthcare Administration, or a related field preferred

Responsibilities

Prepare and submit claims for pediatric therapy, applied behavior analysis, Prescribed Pediatric Extended Care, and adult day health services across multiple billing systems
Review service documentation, coding, modifier application, eligibility, and authorization status prior to claim submission
Identify and correct clearinghouse rejections and front-end claim edits
Maintain program-specific submission schedules to ensure consistent and timely filing
Support the transition of adult day health billing from a monthly to a weekly submission cycle
Research, correct, and resubmit denied and rejected claims for the Prescribed Pediatric Extended Care program
Categorize denials by reason code and identify root cause, whether billing, coding, authorization, eligibility, or documentation
Prepare and file formal appeals within payer-specific filing and appeal timeframes
Track appeals to resolution and escalate non-responsive payers to the Chief Financial Officer
Monitor timely filing deadlines and prioritize claim work by dollars at risk and days remaining
Submit and track prior authorization requests, renewals, and supporting documentation for the Prescribed Pediatric Extended Care program
Cross-train on pediatric therapy authorization workflows to provide backup coverage during absences
Provide backup coverage for claim submission for other programs as needed
Monitor Kentucky Medicaid and managed care policy changes — fee schedules, code sets, and modifier requirements — and communicate updates to the Chief Financial Officer
Serve as a point of contact with payer representatives for routine claim and reimbursement matters
Ensure billing practices comply with payer policies, healthcare billing regulations, and organizational procedures
Prepare daily deposits and associated supporting documentation
Compile a monthly denial report by program and reason code for the Chief Financial Officer
Support internal and external audits by providing requested claim documentation and payer correspondence
Maintain accurate billing records, supporting documentation, and audit trails in accordance with HIPAA