Revenue Cycle Coverage Specialist

Job Summary :

The CNE Revenue Cycle Coverage Specialist is a key contributor to the success of the revenue cycle team, ensuring claims and billing processes run smoothly and efficiently. In this role the specialist takes ownership of identifying and resolving claim edits and charge review errors, verifying insurance and patient registration details, and troubleshooting denials tied to inaccurate payor information. Their attention to detail and problem-solving skills directly support optimal reimbursement and a seamless patient billing experience.

Duties and Responsibilities :

Accurately capture and update billing information to ensure timely and seamless claim submission.

Proactively identify and resolve claim edits, charge review errors, and billing issues tied to registration or insurance discrepancies.

Confirm insurance eligibility and coverage details to avoid delays in claim processing.

Investigate and correct denials caused by inaccurate or incomplete payor information.

Monitor trends in claim edits and denials, and share insights to drive continuous improvement.

Work collaboratively with payors, patients, and internal teams to gather missing information and expedite claim resolution.

Maintain thorough documentation and stay compliant with all timely filing requirements and regulatory standards.

Flag critical billing or insurance issues to leadership and contribute actionable solutions for process enhancements.

Support team success by pitching in where needed, fostering collaboration, and protecting patient confidentiality.

Take on additional tasks as needed to keep the revenue cycle running smoothly.

Manage priorities effectively, staying flexible and responsive to shifting workflows and department needs.

Consistently meet deadlines and performance expectations through organized, focused work habits.

Offer suggestions to improve systems, services, and tools that enhance overall efficiency.

Apply sound judgment when making decisions, relying on knowledge of policies and best practices.

Build strong relationships with both internal and external customers through proactive and attentive service.

Recognize the impact of customer interactions on organizational goals and uphold high service standards.

Follow established protocols and leverage available tools to deliver dependable support.

Communicate openly and effectively across departments and organizational levels.

Requirements :

Must possess a high school diploma or equivalent.

Minimum of 1-3 years of previous customer service experience in a healthcare or business environment required.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation's top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement : External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement : Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement : Employee conducts himself / herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.