Revenue Cycle Specialist I

Location: Nashville, TN

Employment Type: Full-Time, M-F hybrid role

Reports to: Director of Revenue Cycle Management

The Revenue Cycle Specialist I is responsible for bridging the gap between clinical services and financial reimbursement, ensuring compliance, minimizing losses, and supporting overall financial health by managing the administrative and financial aspects of patient care.

Responsibilities:

• Support accurate data entry and insurance verification as needed to ensure claims are billed and paid in a timely manner.

• Maintain general understanding of diagnosis and procedural coding rules to effectively follow up on claims and resolve issues.

• Communicate with patients to verify insurance details, inform them about their billing statements, and answer any questions about medical charges.

• Ensure all claims are submitted accurately and in compliance with healthcare laws to insurance carriers, Medicare, Medicaid, and other payers using various electronic systems.

• Complete claims follow up as necessary on billed claims, by communicating directly with insurance carriers via phone, payer portals, and written correspondence to clarify denial reasons, obtain claim status updates, and advocate for appropriate reimbursement.

• Support the payment process, including generating patient billing statements, assisting patients with payment plans, tracking payments from insurance companies and patients, and applying payments to the appropriate accounts.

• Research and resolve claim denials, underpayments, and any coding-related issues.

• Participate in process improvement initiatives to increase efficiency.

• Collaborate closely with coding, billing, and clinical teams to obtain, review, and submit supporting medical documentation, physician statements, and claim corrections as needed to resolve claims.

• Stay up to date on all federal and state regulations, as well as specific insurance company guidelines.

• Maintain detailed documentation of all claim actions, payer communications, and appeal outcomes to support audits and reporting.

Qualifications:

• 1 – 2 years of charge entry and medical billing experience.

• Strong proficiency in Microsoft 365 (Outlook, Word, Excel, Teams, etc.), with the ability to quickly adapt to new tools and systems.

• Working knowledge of medical billing processes, claim life cycles, and payer reimbursement.

• Familiarity with CPT, ICD-10, and HCPCS coding concepts.

• Experience using electronic health record (EHR) and/or medical billing software.

• Excellent verbal and written communication skills.

• Exceptionally proactive, organized, and detail oriented.

This job description is not intended to be an exhaustive list of all job responsibilities or qualifications associated with the position. The Company reserves the right to modify, add, or remove duties, and to assign other responsibilities as necessary to meet business needs, consistent with the employee’s position, qualifications, and applicable law.