Revenue Cycle Specialist (FT)

Family Health West•Fruita, CO

4d•Onsite

About The Position

The Revenue Cycle Specialist is responsible for managing patient accounts, ensuring accurate and compliant billing, processing claims, reconciling payments, and handling denied claims. This role also involves patient billing and customer service, maintaining knowledge of healthcare regulations, and collaborating with internal departments to ensure a smooth revenue cycle workflow.

Requirements

High School Diploma or GED preferred.
Minimum of 2-3 years of experience in medical billing, coding, or revenue cycle management.
Experience in a healthcare setting is preferred.
Knowledge of healthcare billing standards using (ICD-10, CPT, HCPCS).
Familiarity with insurance verification, claims submission, and denial management.
Strong communication skills, both verbal and written, for patient interactions and collaboration with internal teams.
Attention to detail and accuracy in processing billing and claims.
Ability to communicate effectively with insurance companies, patients, and internal teams.
Knowledge of HIPAA regulations and healthcare compliance.

Nice To Haves

Proficiency in using healthcare management software (e.g., Epic, Cerner, PCIS, ECW).

Responsibilities

Process patient accounts, ensuring accurate billing in accordance with healthcare regulations.
Work with coding for accuracy and completeness.
Verify insurance coverage for patients and obtain necessary authorizations and referrals.
Submit insurance claims in a timely manner, following proper coding and billing protocols.
Address claim rejections and denials promptly.
Reconcile payments and resolve discrepancies.
Investigate denied claims and work towards resolution.
Follow up on unpaid or underpaid claims.
Document all actions taken for future reference.
Assist patients with billing inquiries, explaining charges, insurance payments, and balances.
Provide support for payment plans or financial assistance programs.
Maintain up-to-date knowledge of insurance policies, billing codes, healthcare regulations, and compliance requirements.
Collaborate with clinical staff, coding, and finance teams to ensure proper documentation and a smooth workflow.