Revenue Cycle Specialist (68652)

Sanitas•Doral, FL

8d•Remote

About The Position

The Revenue Cycle Specialist supports the daily operations of the revenue revenue cycle department, analyzing billing data, investigating denial trends, and processing claim corrections, in order to optimize reimbursement rates, ensure data accuracy, and assist management in financial reporting. Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.

Requirements

Bachelor’s degree.
3 years of work-related experience.
Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process.
Proven experience in healthcare billing.
Knowledge of basic insurance policies, procedures, and reimbursement.
Attention to Detail: High level of accuracy in data entry and reviewing medical claims to prevent errors.
Analytical Thinking: Ability to identify billing trends and solve basic payment issues.
Organization: Strong organizational skills to prioritize tasks, track deadlines, and manage open claims effectively.
Technical Skills: Proficiency in Microsoft Excel (formulas, spreadsheets) and experience with practice management software
Communication: Clear verbal and written communication skills to interact with insurance companies and internal teams.
Advanced English is required.

Nice To Haves

Bachelor's degree in Health Information Management, Business, Finance, Accounting, or a related field; or equivalent combination of education and experience
3+ years of progressive revenue cycle experience in a healthcare provider setting, including direct experience with claim denials, payer appeals, and payment reconciliation
Working knowledge of ICD-10, CPT coding conventions, and payer billing requirements
Experience with Medicare, Medicaid, and commercial payer billing rules
Proficient knowledge in Excel
Bilingual Spanish is preferred.

Responsibilities

Analyze claim denials and rejection trends, reviewing explanations of benefits and coordinating with coding teams to submit timely appeals, in order to recover revenue and minimize uncollectible debt.
Generate and maintain routine financial and operational reports, extracting data from the Electronic Health Record and tracking Key Performance Indicators (KPIs), in order to provide visibility on revenue performance to the leadership team.
Assist in the maintenance of payers, charge master and fee schedules, updating system configurations and vendors based on CMS guidelines and payer contract changes under the Manager's supervision, in order to ensure billing compliance and claim accuracy.
Audit patient accounts and billing records, verifying demographic and insurance information against payer requirements and internal policies, in order to prevent front-end rejections and ensure clean claim submission.
Collaborate with the RCM vendors and internal departments, providing specific case examples and documentation for issue resolution, in order to facilitate smooth billing operations and efficient problem-solving.
Daily interaction with Operations team.
Payment posting, tracking, and reconciliation.
Responsible for RCM workflow review and updates for center operations.
Prepare and generate ADHOC reports in a daily, monthly, and quarterly basis.
Identify Revenue cycle bottlenecks and recommend strategies for optimization.