Revenue Cycle Specialist

SanStone Health & Rehabilitation is seeking a Revenue Cycle Specialist.  The Revenue Cycle Specialist is a key contributor to the financial success of the organization. This role will lead training initiatives across the revenue cycle team, ensuring consistent application of best billing practices and payer regulatory requirements. The role will also be responsible for managing complex claims, Medicare informational billing, and accounts receivable follow-up.

The ideal candidate is analytical, organized, and able to manage multiple processes under tight deadlines. They should demonstrate patience, thrive in a fast-paced environment, possess strong follow-through, and have the ability to train staff with diverse learning styles using creative and effective methods.

Key Responsibilities :

• Revenue Cycle Training :
• Develop and deliver training programs for new and existing staff on billing procedures, payer guidelines, and system workflows.
• Serve as a subject matter expert and resource for revenue cycle education and process improvement.
• Update and maintain department standard operating procedure manuals
• Complex Claims Management :
• Handle high-level, complex claims requiring advanced knowledge of payer rules and documentation.
• Collaborate with clinical and administrative teams to resolve claim issues and ensure timely reimbursement.
• Billing & Follow-Up :
• Prepare and submit Medicare informational claims accurately and in compliance with Centers for Medicare & Medicaid Services (CMS) guidelines.
• Conduct thorough follow-up on Medicare accounts receivable to ensure timely and complete payment.
• Monitor and resolve denials, appeals, and underpayments related to Medicare claims.
• Medicaid Pending
• Compliance & Documentation :
• Ensure all billing activities comply with federal, state, and payer-specific regulations.
• Maintain compliance with HIPPA, payer guidelines, and internal policies
• Maintain detailed documentation of claim activity, training records, and process updates.
• Reporting & Analysis :
• Generate reports on claim status, AR aging, and training effectiveness.
• Identify trends and recommend improvements to enhance revenue cycle performance.
• Assist in month-end close, and financial reporting processes.
• Regional AR Specialist Support :
• Provide support and backfill coverage for Regional AR Specialist as needed

Qualifications and Experience :

Benefits :

At SanStone Health and Rehab, we offer employment opportunities in North Carolina that are filled with purpose.  We are an organization that is dedicated to making a difference in our industry and caring as passionately for our employees as we do our residents. SanStone Health and Rehab offers an excellent benefit package to full-time employees including PTO, medical, dental, vision, pharmacy and 401K plan with employer match.