Hoskinson Health & Wellness Clinic
Join us as a
Revenue Cycle Specialist
at
Hoskinson Health & Wellness Clinic
and play a crucial role in managing billing, claims, and collections to ensure timely reimbursement for clinical services. You will verify insurance, review coding, submit claims, follow up on denials, and assist patients with billing inquiries while maintaining compliance with payer requirements and coordinating with patient registration, clinical staff, and the billing department.
Supervisory Role This position does not typically supervise others, but may serve as a team lead or mentor to new billing or patient financial services staff in larger clinic settings.
Key Responsibilities
Prepares and submits clean claims to insurance payers accurately and on time.
Reviews charges for completeness and accuracy, verifying
CPT/ICD-10
coding and modifiers.
Posts payments, adjustments, and denials to patient accounts.
Monitors claim status and promptly resolves rejections or unpaid claims.
Rebills and appeals claims as necessary to ensure full reimbursement.
Maintains up-to-date knowledge of payer submission guidelines and policies.
Insurance Verification & Authorization
Verifies patient insurance eligibility and benefits prior to service.
Obtains required authorizations and referrals.
Communicates with patients and clinical staff to resolve coverage issues or pre‑authorization needs.
Accounts Receivable & Collections
Tracks and manages accounts receivable by payer and patient category.
Contacts payers regarding claim status, missing data, or delayed payments.
Analyzes denials to identify trends and recommends corrective actions.
Manages patient balances and assists with payment plans or financial assistance programs.
Compliance & Documentation
Maintains compliance with
HIPAA , payer requirements, and internal billing policies.
Ensures documentation supports charges and audit readiness.
Participates in internal and external audits as needed.
Stays informed on regulatory and reimbursement updates.
Communication & Coordination
Collaborates with front office, clinical, and finance teams to resolve billing discrepancies.
Provides feedback to coders and clinical staff regarding missing or incomplete documentation.
Communicates clearly and professionally with patients about billing questions, balances, or insurance concerns.
Education, Certifications & Licensure
Required:
High school diploma or equivalent.
Preferred:
Associate degree in Health Administration, Business, Accounting, or related field.
Professional certifications:
CPB – Certified Professional Biller (AAPC)
CRCR – Certified Revenue Cycle Representative (HFMA)
CCA / CPC – Certified Coding Associate or Certified Professional Coder (if handling coding tasks)
Experience
Required:
2–4 years of experience in healthcare billing, claims, or revenue cycle operations; strong knowledge of insurance claim processes, CPT/ICD-10/HCPCS codes, and payer requirements; proficiency in EHR and billing systems.
Preferred:
Experience in a clinic or ambulatory care environment; familiarity with multiple payer types (commercial, Medicare, Medicaid, workers comp); experience with clearinghouses or revenue cycle management software.
Required Skills & Abilities
Strong attention to detail and data accuracy.
Excellent understanding of reimbursement processes and payer rules.
Effective problem‑solving and follow‑up abilities.
Strong written and verbal communication with patients, payers, and team members.
Proficiency in Microsoft Office (Excel, Outlook) and billing software systems.
Ability to multitask and prioritize in a fast‑paced environment.
High level of integrity and commitment to maintaining patient confidentiality.
Additional Information
Seniority level: Mid‑Senior level.
Employment type: Full‑time.
Job function: Accounting/Auditing and Finance.
Industry: Hospitals and Health Care.
#J-18808-Ljbffr
Revenue Cycle Specialist
at
Hoskinson Health & Wellness Clinic
and play a crucial role in managing billing, claims, and collections to ensure timely reimbursement for clinical services. You will verify insurance, review coding, submit claims, follow up on denials, and assist patients with billing inquiries while maintaining compliance with payer requirements and coordinating with patient registration, clinical staff, and the billing department.
Supervisory Role This position does not typically supervise others, but may serve as a team lead or mentor to new billing or patient financial services staff in larger clinic settings.
Key Responsibilities
Prepares and submits clean claims to insurance payers accurately and on time.
Reviews charges for completeness and accuracy, verifying
CPT/ICD-10
coding and modifiers.
Posts payments, adjustments, and denials to patient accounts.
Monitors claim status and promptly resolves rejections or unpaid claims.
Rebills and appeals claims as necessary to ensure full reimbursement.
Maintains up-to-date knowledge of payer submission guidelines and policies.
Insurance Verification & Authorization
Verifies patient insurance eligibility and benefits prior to service.
Obtains required authorizations and referrals.
Communicates with patients and clinical staff to resolve coverage issues or pre‑authorization needs.
Accounts Receivable & Collections
Tracks and manages accounts receivable by payer and patient category.
Contacts payers regarding claim status, missing data, or delayed payments.
Analyzes denials to identify trends and recommends corrective actions.
Manages patient balances and assists with payment plans or financial assistance programs.
Compliance & Documentation
Maintains compliance with
HIPAA , payer requirements, and internal billing policies.
Ensures documentation supports charges and audit readiness.
Participates in internal and external audits as needed.
Stays informed on regulatory and reimbursement updates.
Communication & Coordination
Collaborates with front office, clinical, and finance teams to resolve billing discrepancies.
Provides feedback to coders and clinical staff regarding missing or incomplete documentation.
Communicates clearly and professionally with patients about billing questions, balances, or insurance concerns.
Education, Certifications & Licensure
Required:
High school diploma or equivalent.
Preferred:
Associate degree in Health Administration, Business, Accounting, or related field.
Professional certifications:
CPB – Certified Professional Biller (AAPC)
CRCR – Certified Revenue Cycle Representative (HFMA)
CCA / CPC – Certified Coding Associate or Certified Professional Coder (if handling coding tasks)
Experience
Required:
2–4 years of experience in healthcare billing, claims, or revenue cycle operations; strong knowledge of insurance claim processes, CPT/ICD-10/HCPCS codes, and payer requirements; proficiency in EHR and billing systems.
Preferred:
Experience in a clinic or ambulatory care environment; familiarity with multiple payer types (commercial, Medicare, Medicaid, workers comp); experience with clearinghouses or revenue cycle management software.
Required Skills & Abilities
Strong attention to detail and data accuracy.
Excellent understanding of reimbursement processes and payer rules.
Effective problem‑solving and follow‑up abilities.
Strong written and verbal communication with patients, payers, and team members.
Proficiency in Microsoft Office (Excel, Outlook) and billing software systems.
Ability to multitask and prioritize in a fast‑paced environment.
High level of integrity and commitment to maintaining patient confidentiality.
Additional Information
Seniority level: Mid‑Senior level.
Employment type: Full‑time.
Job function: Accounting/Auditing and Finance.
Industry: Hospitals and Health Care.
#J-18808-Ljbffr