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Healthcare Revenue Cycle Specialist

2 months ago

Sacramento, California, United States Retinal Consultants Full time
Position Overview:

We are a reputable medical practice focused on the diagnosis and treatment of retinal and vitreous diseases. We are seeking a dedicated individual to fill the role of a full-time Revenue Cycle Analyst. This position will report directly to the Revenue Cycle Manager, who oversees the operations of the Revenue Cycle Management team.

Key Responsibilities:
  • Conducting thorough reviews of Accounts Receivable (AR) Aging to identify and resolve problematic claims.
  • Engaging with insurance payers to address and rectify outstanding claims.
  • Providing insights and recommendations to enhance the claims processing workflow.
  • Analyzing AR credit balances to ascertain accurate refund amounts owed to either insurance payers or patients, and initiating refunds and adjustments as necessary.
  • Supporting the credentialing and contracting processes for providers and practices.
  • Assisting with payer audit requests related to claims.
  • Responding to various inquiries from payers, including requests for medical records and updates to provider directories.
  • Analyzing denial trends and proposing strategies to minimize future denials.
  • Completing additional tasks and projects as assigned.
Qualifications:
  • A minimum of 3 years of experience in AR follow-up for physician office visits and diagnostic testing claims.
  • Proficient analytical and problem-solving skills to effectively address unpaid claims, including the appeals process.
  • Strong proficiency in Excel for managing and summarizing extensive data sets (e.g., pivot tables, vlookups, conditional formulas, sorting).
  • Ability to work autonomously.
  • Excellent communication and interpersonal skills.
Preferred Qualifications:
  • Experience with payer credentialing and contracting.
  • Knowledge of full cycle claims processing, including authorizations, eligibility verification, coding, and claims follow-up.
  • Familiarity with NextGen practice management software.