Revenue Cycle Management Specialist

Job Summary

Owning the end-to-end life of claims, the full-time Revenue Cycle Management Specialist will manage payer authorizations, claim submissions, and resolution of denials while ensuring data integrity and compliance in a clerical role.

Key Responsibilities

• Obtain and validate prior authorizations and verify member eligibility and benefits
• Prepare, review, and submit clean claims to various payers while ensuring compliance with payer-specific billing rules
• Analyze denials and remittance advice to determine appropriate actions and work on appeals and A/R follow-up

Required Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree in a related field preferred
• 3+ years of hands-on medical billing or revenue cycle experience
• Experience with prior authorization workflows across various payer types
• Working knowledge of CPT, HCPCS, ICD-10, and medical terminology
• Proficiency in Microsoft Excel and experience with billing/EMR platforms