Revenue Cycle Specialist
On-sitePhiladelphia, Pennsylvania, United States
Job Summary
Prepare and submit accurate inpatient medical claims to insurance companies and government entities, clearing edits for clean submission. Post payments, review Electronic Remittance Advice for accuracy, and alert the AR follow-up team of denials. Monitor work queues to resolve unpaid claims with payors, patients, and departments while reporting trends in denied claims or payment discrepancies to management. Submit reconsiderations and appeals using payor documentation and portals to resolve under/overpayments. Independently respond to requests and interact professionally with internal and external stakeholders to ensure timely and accurate account resolution.
Required Qualifications
- High school diploma or GED
- 1-2 years of healthcare revenue cycle experience within a Hospital setting
- Knowledge of medical terminology such as CPT, HCPCS, APC, ASC, DRG and ICD10
- Strong proficiency in Microsoft Excel
- Ability to communicate clearly (both written and verbal)
- Knowledge of State and Federal healthcare guidelines and regulations
- Demonstrated experience with reviewing outstanding balances to resolution (Medicare, Medicaid, and Commercial payors)
- Exceptional time management and organizational skills
- Ability to direct work with minimal supervision and ability to meet performance and quality goals
Desired Qualifications
- Bachelor's degree
- Associate or Industry Certification
- Demonstrated understanding of, healthcare terminology, insurance plans and contract language
- Experience working with Epic or other related EHR
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