Revenue Cycle Specialist in Memphis, Tennessee at Eye Specialty Group

Revenue Cycle Specialist

E/O/E

Position Summary

The Revenue Cycle Specialist is responsible for managing outstanding accounts receivable by responding to payer requests, reviewing and auditing medical records, resolving claim denials, and pursuing reimbursement opportunities. This position serves as a key liaison between providers, coding, billing, and insurance payers to ensure claims are submitted accurately, payer inquiries are addressed timely, and all appropriate reimbursement opportunities are maximized.

Essential Duties and Responsibilities

Payer Requests and Medical Record Review

• Monitor and respond to outstanding payer requests for medical records, claim documentation, and additional information.
• Review patient charts for completeness, accuracy, and compliance prior to submission to insurance payers.
• Audit clinical documentation to ensure it supports billed services, diagnosis codes, procedure codes, and payer requirements.
• Coordinate with providers and clinical staff to obtain missing documentation and resolve chart deficiencies.
• Ensure all payer requests are completed and submitted within required filing deadlines.

Denial Management and Claim Resolution

• Investigate denied, rejected, and underpaid claims to determine root causes and identify corrective actions.
• Analyze payer denial trends and recommend process improvements to reduce future denials.
• Review denied claims and determine opportunities for claim correction, rebilling, appeal, or alternative reimbursement.
• Research appropriate CPT, HCPCS, ICD-10, and modifier usage to support accurate claim reconstruction and resubmission.
• Rebill and resubmit claims when documentation supports reimbursement opportunities.

Appeals and Follow-Up

• Prepare and submit first-level, second level, and payer-specific appeals with supporting documentation.
• Draft appeal letters and compile medical records, coding references, and payer guidelines as necessary.
• Track appeal status and follow up with payers to ensure timely review and resolution.
• Maintain detailed documentation of all appeal activities and payer communications.

Accounts Receivable and Claims Follow-Up

• Perform follow-up activities on outstanding claims to secure payment and reduce aging accounts receivable.
• Contact insurance companies regarding claim status, payment delays, denials, and reimbursement discrepancies.
• Identify and resolve billing edits, claim rejections, and payer processing issues.
• Monitor claim inventory to ensure timely account resolution and adherence to filing deadlines.
• Escalate complex reimbursement issues to leadership as appropriate.

Compliance and Reporting

• Maintain compliance with federal, state, payer, and organizational billing requirements.
• Stay current on payer policies, coding updates, and reimbursement regulations.
• Assist with reporting related to denials, appeals, payer requests, and accounts receivable performance.
• Participate in revenue cycle improvement initiatives to increase reimbursement and reduce claim denials.

Education

• High School Diploma or GED required.
• Associate’s or Bachelor’s degree in Healthcare Administration, Business, Health Information Management, or related field preferred.
• COT/COA or equivalent experience preferred

Experience

• Minimum of 2 years of experience in medical billing, revenue cycle, accounts receivable, denial management, or insurance follow-up required.
• Experience with medical record review, payer audits, appeals, and claim correction preferred.
• Experience with EMR and practice management systems required.

Knowledge, Skills, and Abilities

• Strong knowledge of CPT, HCPCS, ICD-10, modifiers, and payer billing guidelines.
• Understanding of commercial, Medicare, Medicaid, and managed care reimbursement methodologies.
• Ability to analyze denials and identify reimbursement opportunities.
• Strong investigative, analytical, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities while meeting deadlines.
• Proficiency in Microsoft Office applications, particularly Excel.

Physical Requirements:

• Ability to sit/stand/walk as the job requires for long periods of time, as well as, climb/balance, lift, push/pull and stoop/crouch as needed.
• Corrected or uncorrected visual acuity in at least one eye of 20/40 or better.
• Ability to operate office equipment requiring the use of one hand.
• Ability to work in a moderate noise level clinic.
• Corrected or uncorrected hearing/speaking capacity to enable suitable telephone communication skills.