Senior ASC Revenue Cycle Management Specialist
About The Position
The Senior ASC Revenue Cycle Specialist supports advanced revenue cycle operations for the Ambulatory Surgery Center, focusing primarily on accounts receivable, denial management, reimbursement optimization, and revenue integrity. The role uses broad end-to-end revenue cycle expertise to resolve complex reimbursement issues, identify trends, improve workflows, and support continuous operational improvement. The specialist works independently and collaborates with leadership and revenue cycle colleagues to maximize reimbursement, improve operational efficiency, and ensure compliance with payer requirements. This is not a supervisory position; the specialist serves as a technical subject matter expert and mentor within the department. The position also contributes to workflow development and documentation, reporting and trend analysis, system and clearinghouse optimization, cross-training, audits, historical A/R projects, reimbursement recovery, and the implementation of new surgery centers and revenue cycle workflows. The work environment offers a hybrid model if desired, with on-site collaboration during the initial transition and training period and flexibility as workflows are established.
Requirements
- Five or more years of progressive medical revenue cycle experience.
- Extensive experience with insurance follow-up, denials, appeals, and accounts receivable.
- Broad end-to-end revenue cycle knowledge, including eligibility, claim submission, payment posting concepts, reimbursement, and collections.
- Experience with Practice Management systems and clearinghouses.
- Strong understanding of payer guidelines, reimbursement methodologies, and EOB interpretation.
- Proficiency with Microsoft Office applications, particularly Excel.
- Ability to analyze reports and identify reimbursement trends.
- Strong investigative, analytical, and problem-solving skills.
- Excellent organizational and time management abilities, with exceptional attention to detail.
- Strong written and verbal communication skills.
- Ability to work independently; self-motivated, professional, collaborative, and accountable.
- Positive, solution-oriented mindset and ability to adapt to changing priorities in a fast-paced healthcare environment.
Nice To Haves
- Associate's degree; equivalent combinations of education and relevant revenue cycle experience will be considered.
- Experience with commercial, Medicare, Medicaid, Workers' Compensation, and other government payers.
- Ambulatory Surgery Center experience.
- Experience with Waystar.
Responsibilities
- Manage complex insurance accounts receivable across all payer types.
- Investigate and resolve denied, underpaid, and outstanding claims.
- Analyze EOBs and remittance advice to verify accurate reimbursement.
- Identify reimbursement discrepancies and recommend account corrections.
- Work timely filing, high-dollar, aging, and specialty queues according to departmental priorities.
- Investigate and resolve payer denials using payer guidelines and contract knowledge.
- Prepare and submit appeals with supporting documentation; monitor appeal outcomes.
- Identify denial trends and recommend corrective actions and reimbursement improvements.
- Collaborate with coding, authorization, and clinical staff to prevent recurring denials.
- Review reimbursement accuracy and contractual payment variances, and assist with payment variance research and revenue recovery.
- Identify payer processing issues and ensure accounts accurately reflect contractual adjustments and patient responsibility.
- Assist leadership in developing and documenting standardized revenue cycle workflows and reference materials.
- Recommend operational improvements that increase efficiency and reduce rework.
- Participate in new revenue cycle initiatives and system enhancements.
- Analyze accounts receivable for reimbursement trends and operational opportunities; assist with KPI monitoring and revenue cycle reporting.
- Recommend priority work queues based on reimbursement impact and report findings to Revenue Cycle leadership.
- Use SIS Complete, Waystar, payer portals, and other revenue cycle systems; research clearinghouse edits, payer rejections, and claim submission issues.
- Assist with payer portal administration and user access as assigned, and support system workflow optimization.
- Serve as a technical resource, assist with cross-training and knowledge sharing, and provide guidance on complex reimbursement scenarios.
- Collaborate with Coding, Payment Posting, Scheduling, Financial Clearance, and Leadership to improve revenue cycle performance.
- Participate in revenue cycle audits, cleanup initiatives, historical A/R projects, and reimbursement recovery efforts.
- Support new surgery center implementations and revenue cycle workflows as the organization grows.
- Perform additional revenue cycle projects as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
