Revenue Cycle Specialist I

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The Revenue Cycle Specialist I is responsible for analyzing and optimizing the financial processes within a healthcare organization, including patient registration, billing, coding, claims submission, and collections, by identifying areas for improvement, monitoring key performance indicators (KPIs), and implementing strategies to maximize revenue while adhering to compliance regulations; essentially acting as a data-driven expert to streamline the revenue cycle and ensure accurate and timely payments from insurance companies and patients.

Responsibilities

• Work closely with Revenue Cycle Business Analysts and Revenue Cycle Financial Analysts, including handling claims and related tasks.
• Prepare Complex Medical Records requests and review documents for accuracy, completeness, and congruency
• Interpret payer correspondence and determine next appropriate action
• Submit carrier appeals and reconsideration requests in a timely manner based on SOPs, or suggest improvements to SOPs
• Review and update line-item receipt posting (LIRP) as needed or handle other posting needs
• Work assigned hold codes and determine next actions including, but not limited to, bad addresses, eligibility, and other denial reasons
• Maintain accurate tracking of client and referring provider documentation and obtain missing documentation to ensure accuracy and completeness
• Ensure all relevant claims and appeal documentation is uploaded into OnBase
• Verify all identified insurance carriers for policy related to prior authorization requirements as needed for claims adjudication
• Collaborate with Coding, Billing, Patient Access, and Cash Receipts Specialists as needed

Qualifications

Aegis Sciences Corporation is an Equal Opportunity Employer

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