Revenue Cycle Specialist (FT)

Family Health West•Fruita, CO

4d•Onsite

About The Position

The Revenue Cycle Specialist is responsible for processing patient accounts, ensuring accurate and compliant billing, managing insurance verification and authorizations, submitting claims, reconciling payments, managing denials, and providing customer service to patients regarding billing inquiries. This role requires a strong understanding of healthcare regulations, coding, and billing standards, as well as proficiency in healthcare management software. Collaboration with other departments is essential for 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.
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

Experience in a healthcare setting is preferred.
Proficiency in using healthcare management software (e.g., Epic, Cerner, PCIS, ECW).

Responsibilities

Process patient accounts, ensuring that all charges for medical services are billed accurately and in accordance with healthcare regulations.
Work with coding for accuracy and completeness.
Verify insurance coverage for patients, ensuring that required authorizations and referrals are obtained for services.
Submit insurance claims in a timely manner, following proper coding and billing protocols.
Ensure compliance with insurance guidelines and address any rejections/denials promptly.
Reconcile payments and resolve discrepancies between payments and charges.
Investigate denied claims, working with insurance carriers and patients to resolve issues.
Follow up on unpaid or underpaid claims to ensure timely reimbursement.
Document all actions taken for future reference.
Assist patients with billing inquiries, ensuring that they understand charges, insurance payments, and balances.
Provide support for payment plans or financial assistance programs if necessary.
Maintain up-to-date knowledge of insurance policies, billing codes, healthcare regulations, and compliance requirements to ensure accurate and legal billing practices.
Work closely with other departments such as clinical staff, coding, and finance teams to ensure proper documentation and smooth workflow throughout the revenue cycle.