Revenue Cycle Specialist

The RCS manages the insurance claims and collection process for an assigned region.

JOB DESCRIPTION (Last updated: July 2025)
Specifications are not intended to reflect all duties performed within the job.
Job title      Revenue Cycle Specialist
Reports to Senior Manager Revenue Cycle Management
Supervisory Responsibilities: None
FLSA Status: Non-Exempt
Job Type: Full-Time

Job Summary        

The Revenue Cycle Specialist (RCS) is responsible for assisting with the day-to-day operations within the Billing Department. The position will be task oriented with assignments provided by the Senior Manager of RCM. Tasks to include submission of corrected claims, reviewing mail specific to billing with follow up on actions needed along with additional task needed to support the Billing Department.

Duties and Responsibilities                         

•  Clean, review, and submit claims for behavioral health providers (specifically autism providers)

•  Track claim statuses and remittances

•  Work denials and follow up with unpaid claims proactively

•  Manage patient responsibility invoices (e.g., patient co-insurance, co-pays)

•  Evaluate insurance operations and identify efficiency improvements

•  Analyze EOBs and post manual payments

•  Submit and follow up on Commercial and Medicaid, primary and secondary insurances

•  Communicate to administrative team for errors and corrections

Work and manage claims from all aging buckets including posting and appeals,

including resubmission of claims and appropriate adjustments.

•  Input and review billing data for accuracy, including data entry.

•  Ensure that billing and collections adhere to all compliance policies and procedures.

•  Work with Billing Manager and local clinic team members to ensure accurate billing.

•  Follows up on claim resolution from initial billing through final resolution including 

identifying and correcting billing errors/rejections and denials (denial management investigations 

& appeals).

•  Manage claims submission and AR for assigned clinics.

•  Process remittance advices/EOB’s to achieve finalized clean claims for payment including researching and correcting denials (Pull EFT back-ups).

•  Post and reconcile payments received using system and deposit reports. Maintain confidentiality of all patient information.

•  Perform other duties as assigned

 

Qualifications 

•  High School or degree in Administration, Healthcare Administration or related field (preferred, but not required).

•  1 year experience in Healthcare within revenue cycle management or medical billing function, preferred but not required. 

•  1 to 3+ years of experience working as an Administrative Assistance

•  Experience in a high growth and fast paced environments

 

Knowledge, Skills and Abilities

•  Advanced level skills in the use of the Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook eMail and Calendar

•  Strong mathematical and analytical skills

•  Detail oriented and deadline driven

•  Ability to read and analyze ERA remittances for appropriate posting and/or denial resolution actions

•  Ability to apply current knowledge to more complex tasks in order to achieve elevated results, leading to continuous improvement

•  Proven ability to work and collaborate with other team members and to maintain a positive attitude

•  High level of integrity and dependability and the ability to manage multiple projects and competing priorities

•  Ability to successfully complete required background and drug screens