Revenue Cycle Specialist

Job Summary

Analyzing and monitoring claims audit data, the full-time Revenue Cycle Specialist will ensure accurate reimbursement to healthcare providers by identifying payment variances and resolving issues remotely.

Key responsibilities

• Analyze and adjust claims to ensure accurate reimbursement rates according to contractual agreements and payer guidelines
• Identify errors in reconciliation files and perform contract and reimbursement variance analysis across multiple work streams
• Provide subject matter expertise on billing and coding guidelines while running standard Revenue Cycle reports for stakeholders

Required qualifications

• 3+ years of relevant experience or equivalent combination of education and work experience
• Claims repricing, pricing configuration, or provider maintenance experience required
• High School Diploma or equivalent required
• Demonstrated knowledge of claims processing, DRG Validation, CMS guidelines, and ICD-10 coding guidelines
• Strong understanding of healthcare revenue cycle and claims reimbursement methodologies