Revenue Cycle Management Specialist

Job Classification : Revenue Cycle Management Specialist

Reports To : Client Services Supervisor

FLSA Status : Full-Time, Exempt

Summary : Reports to the Client Services Supervisor. The Revenue Cycle Management Specialist is responsible for managing the end-to-end medical billing process, including claim submission, payment posting, denial resolution, and reconciliation across EMR and QuickBooks systems and payer compliance to ensure timely and accurate revenue collection for the organization. . This position ensures compliance with payer contracts and coding standards, promotes accurate reimbursements, and supports financial transparency. The role plays a vital part in maintaining the organization's financial health, improving cash flow, and ensuring alignment with private insurance carrier agreements.

The Revenue Cycle Management Specialist must have a strong understating of CPT, ICD-10 and insurance billing codes, as well as, working knowledge of payer contracts, private carrier reimbursement methodologies, and compliance requirements, The incumbent ensures that all claims are processed correctly, reimbursement are maximized, and revenue is maintained through careful monitoring, auditing, and collaboration with internal departments and payers. The role supports and enhances the insurance billing function through diligent claim management, payer communication, and reconciliation activities that promote accurate reimbursement and financial transparency.

Essential Duties and Responsibilities :

Insurance Claims Management

• Verify CPT codes prior to claim submission in the EMR system to ensure compliance and maximize reimbursement.
• Collaborate with coding and revenue cycle teams to resolve complex CPT coding issues beyond standard expertise.
• Prepare, review, and submit insurance claims through the EMR system, ensuring compliance with payer-specific and contractual requirements.
• Monitor and manage claim submissions to ensure accuracy, timely filing, and proper follow-up on rejections or denials.
• Research claim denials and rejections, determine root causes, and take corrective actions to resolve issues promptly.
• Revise and resubmit corrected claims with necessary documentation and coding updates to secure proper reimbursement.
• Participate in weekly meetings with clinic leadership to analyze denials, rejections, and claim status for continuous improvement.
• Monitor the adjudication of submitted claims to verify timely processing, accuracy, and alignment with contracted reimbursement rates.
• Represent and advocate for corrected or underpaid claims during follow-up with insurance carriers.
• Ensure all billing activities comply with payer contracts, including fee schedules, covered services, and filing deadlines established by private carriers.

Payment Processing

Contract Compliance and Payer Relations

Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Influenza immunization

While performing the duties of this job, the employee is regularly required to talk and hear.

Empowerment Resource Center (ERC) values a diverse, respectful, and collaborative work environment. We establish and maintain trustful relationships with our staff, partners, funders, and the communities that we are privileged to serve. ERC makes all hiring and employment decisions without regard to race, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, physical or mental disability, sexual orientation, sexual identity, immigrant status, political affiliation or belief, exoffender status (depending on the offense and position to be filled), and / or unfavorable military discharge.

Hiring Salary Range : $45,000 - $50,000 Commensurate with experience and qualifications.

Status : Full-Time

Travel : Travel is not required for this position.

How to Apply : Please apply through ERC website www.erc-inc.org. No Phone Calls Please.