Revenue Cycle Specialist

• Claims Processing & Resolution: Executes pre-submission reviews to ensure maximum accuracy across Medicare, Medicaid, and commercial claims, while efficiently resolving clearinghouse and payer rejections for timely re-submission under strict deadlines

• Denial Management: Research denied or underpaid claims, corrects errors, and submits appeals or adjusted claims within strict payer deadlines to maximize revenue recovery.

• Accounts Receivable Follow-Up: Monitors aged A/R claims and communicates directly with insurance payers to identify unpaid claims, investigate processing delays, and secure timely reimbursement

• Compliance and Coding: Ensure all billing practices comply with HIPAA regulations and internal PCG/client policies.

• Invoicing : Reviews patient statements for accuracy and mail statements

• Client/Provider/Submitter Questions : Answers provider, submitter, client questions regarding claims and claims related issues

• Any other duties assigned and relevant to the RCM of the project

Required Skills

• Ability to change tasks proficiently, cognitive flexibility (ability to quickly adjust your focus and mindset to meet new project demands without sacrificing performance)

• Working knowledge of Medicare, Medicaid, Commercial Payer Portals and how to obtain claim status and create appeals.

• Ability to organize and analyze data

• Maintain revenue cycle integrity by accurately executing standardized billing processes under tight deadlines, demonstrating strong attention to detail, and proactively escalating complex account issues to supervisor/manager.

• Proficiency with Microsoft Office, particularly Excel

• Problem solving skills including the ability to identify issues and proactively make recommendations to resolve

Qualifications

• High School Diploma or equivalent required

• 2 - 3 Years Relevant Revenue Cycle/Medical Billing Experience

• Coding Certificate a plus

• Proficiency in Advance Data Systems( ADS) Medics Premier preferred

Supervisory Responsibility

• None

Working Conditions

• Office Setting