Specialist, Revenue Cycle Management

Suvida Healthcare

About The Position

The Revenue Cycle Management (RCM) Specialist oversees the billing and payment process within a healthcare organization. The role covers insurance verification, charge entry and coding, claims submission, rejection and denial resolution, accounts receivable follow-up, patient billing, compliance documentation, reporting, and collaboration with healthcare providers, insurers, and internal teams. The specialist helps ensure accurate and timely reimbursement, resolve billing issues, comply with healthcare and payer requirements, and improve revenue-cycle operations.

Requirements

High school diploma or GED.
At least 3 years of end-to-end billing experience.
Attention to detail.
Intermediate Excel skills.

Nice To Haves

Medical Billing & Coding Certification.
Value-based care experience.

Responsibilities

Verify patient insurance eligibility and benefits before scheduled visits through payer portals and eligibility tools; confirm active coverage, plan type including D-SNP or dual status, and PCP assignment; resolve discrepancies; and document and tag coverage in Collectly.
Enter and code medical charges based on services provided, using ICD-10, CPT, and HCPCS codes appropriately.
Prepare and submit complete, accurate insurance claims electronically or on paper in accordance with payer requirements.
Review claim rejections in Elation and the PMS, resolve them, and resubmit rejected claims.
Investigate claim denials and rejections, correct errors, and resubmit claims as needed.
Monitor accounts receivable, follow up on unpaid claims, contact payers for status updates, and resolve payment issues.
Generate and send patient statements; respond to patient questions about bills, payments, and insurance; and establish payment plans when necessary.
Comply with federal and state regulations and payer-specific requirements, and maintain accurate, organized billing records and documentation.
Generate and analyze billing reports, track performance metrics, identify trends, recommend process improvements, and publish billing KPIs monthly.
Collaborate with healthcare providers, insurance companies, and internal teams to resolve billing issues and improve processes.