Revenue Cycle Specialist- Billing

JOB SUMMARY

Under the supervision of the Revenue Cycle Manager, the Revenue Cycle Specialist – FQHC Billing is responsible for timely, accurate, and compliant billing, follow-up, payment reconciliation, and account resolution for Friend Health – HRDI. This position requires working knowledge of Federally Qualified Health Center (FQHC) billing requirements, with particular attention to Medicare FQHC billing, the Medicare Prospective Payment System (PPS), and applicable Medicare Advantage supplemental or wrap payment processes. The specialist reviews patient accounts and claims for correct payer, provider, coding, revenue code, and encounter information; researches denials and underpayments; and collaborates with clinical, billing, credentialing, finance, and payer representatives to support compliant reimbursement and the financial stability of the organization.

JOB DUTIES

• Review and process FQHC claims to support accurate charge capture, coding, claim submission, and reimbursement in accordance with payer and organizational requirements. 
• Apply working knowledge of FQHC billing guidelines, including Medicare FQHC billing requirements, Medicare PPS methodology, qualifying visit requirements, and applicable Medicare Advantage supplemental or wrap payment processes.
• Review claims for correct payer, financial class, provider, place of service, CPT/HCPCS, modifiers, revenue codes, diagnosis coding, and other data elements required for compliant FQHC billing.
• Monitor Medicare and Medicare Advantage claims for appropriate payment, supplemental/wrap reimbursement, underpayments, denials, rejections, and payment variances; research and escalate discrepancies as needed.
• Reconcile expected reimbursement to remittance activity, including ERAs/835s, EFTs, contractual adjustments, patient responsibility, and supplemental payments when applicable.
• Verify insurance eligibility, benefits, coordination of benefits, and authorization requirements before claim submission or follow-up.
• Follow up on unpaid, denied, rejected, and underpaid claims within established payer filing and appeal deadlines.
• Identify payer-specific billing edits, claim trends, and recurring denial root causes and communicate findings to Revenue Cycle leadership.
• Work collaboratively with clinical, coding, credentialing, front desk, finance, and payer representatives to resolve billing and reimbursement issues.
• Maintain documentation of claim corrections, appeals, payer contacts, and account actions in accordance with organizational standards.
• Support month-end reconciliation and reporting by identifying outstanding FQHC, Medicare, and wrap/supplemental payment issues that may affect accounts receivable.
• Participate in billing education, quality assurance, process improvement, department meetings, and payer training as required.
• Perform other related duties as assigned.

QUALIFICATIONS

• High school diploma or equivalent required.
• Associate degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field preferred.
• Three (3) to five (5) years of experience in revenue cycle, medical billing, claims follow-up, or patient accounts within a healthcare setting; FQHC experience strongly preferred.
• Demonstrated knowledge of Federally Qualified Health Center (FQHC) billing guidelines and reimbursement requirements.
• Working knowledge of Medicare FQHC billing, Medicare PPS, and applicable Medicare Advantage supplemental or wrap payment guidelines.
• Ability to review remittance advice and identify incorrect payment, underpayment, denial, adjustment, or missing supplemental reimbursement.
• Knowledge of payer-specific billing rules, timely filing requirements, appeals, eligibility, coordination of benefits, and authorization processes.
• Comprehensive knowledge of medical terminology and ICD-10-CM, CPT, and HCPCS coding principles; ability to recognize when coding or modifier issues require escalation to coding staff.
• Proficiency with electronic health records, practice management/billing systems, clearinghouses, payer portals, and Microsoft Office Suite.
• Strong analytical skills and attention to detail with the ability to reconcile claims, payments, adjustments, and account balances.
• Ability to manage multiple priorities in a fast-paced environment and meet productivity, quality, and follow-up expectations.
• Strong written and verbal communication skills and the ability to collaborate effectively across departments and with external payers

SMART GOALS

• Improve Claims Accuracy

Reduce avoidable FQHC billing errors, claim rejections, and preventable denials by 10% within the first 6 months through accurate claim review, payer guideline application, and timely correction

• Enhance Collections Performance

Review assigned Medicare and Medicare Advantage accounts for payment accuracy and applicable supplemental/wrap reimbursement, with identified variances researched or escalated within established departmental timeframes.

• Optimize Revenue Cycle Efficiency

Maintain timely claim follow-up and account resolution while meeting established productivity, quality, and documentation standards.

WORKING CONDITIONS

 The unavoidable, externally imposed conditions under which the work must be performed, and which create hardship for the incumbent including the frequency and duration of occurrence of physical demands, environmental conditions, demands on one’s senses, and mental demands.) None known.

PHYSICAL REQUIREMENTS

• Frequent use of hands, fingers, and wrists for typing, data entry, and handling office equipment.
• Occasional standing, walking, bending, and reaching.
• Ability to lift and carry up to 15 pounds (files, records, or office supplies) as needed.
• Ability to communicate effectively in person, over the phone, and via electronic systems.
• Must maintain regular and predictable attendance.

EMPLOYMENT CONDITIONS

This job description is to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee’s ability to perform the duties as described. This job description is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned as deemed appropriate commensurate to the position. This document does not represent a contract of employment, and Friend Health - HRDI reserves the right to change this job description and /or assign tasks deemed as needed.

BENEFITS & COMPENSATION

Salary: $55,000

• Medical, Dental, and Vision Insurance
• 403(b) Retirement Plan 
• Paid Time Off (PTO) & Paid Holidays
• Life Insurance & Disability Coverage
• Tuition Reimbursement & Professional Development Opportunities
• Wellness Programs & Employee Assistance Programs (EAP)
• Equal Employment Opportunity (EEO) Statement

Friend Health – HRDI is an equal opportunity employer. We consider all applicants for employment without regard to race, religion, color, age, sex, national origin, citizenship, ancestry, marital or parental status, sexual orientation including gender identity, gender expression, military discharge status, physical or mental disability, or any other status or characteristic protected by law. In addition, Friend Health – HRDI provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local laws (including during the application or hiring process). Friend Health - HRDI supports the Pay Transparency Law as an equal opportunity employer.

Join our Team!

At Friend Health – HRDI, our employees are at the heart of our mission. As a Revenue Cycle Specialist – FQHC Billing, you will play an important role in supporting accurate and timely reimbursement while helping strengthen the financial operations that support patient care. We are seeking a detail-oriented revenue cycle professional with strong healthcare billing knowledge who is ready to contribute in a collaborative, mission-driven environment.