Healthcare Revenue Cycle Specialist

2 weeks ago


Valencia, California, United States Shield HealthCare Full time
Job Overview

Since its inception in 1957, Shield Healthcare has been committed to delivering exceptional healthcare services, prioritizing both customer satisfaction and employee success. Our mission is to meet the medical supply needs of consumers and the caregiving community, all while maintaining an impressive 99% overall customer satisfaction rating. Over the years, we have expanded our reach nationally, with service locations across various states.

We are currently seeking a Healthcare Revenue Cycle Specialist to evaluate the medical claims billing process, identifying solutions for payer rejections and denials. This role requires effective collaboration with cross-functional teams and strong analytical skills. The specialist will assist in managing departmental workflows, prioritizing projects, and driving positive financial results.

Key Responsibilities:
  • Develop advanced reports and models in Microsoft Excel to showcase reimbursement trends and outcomes.
  • Extract and analyze data from databases utilizing AS400 queries, SQL queries, and Microsoft Power BI.
  • Conduct trend analyses to address challenges within the revenue cycle, focusing on resolving payer rejections, denials, and underpayments.
  • Present both quantitative and qualitative findings clearly and effectively.
  • Work collaboratively with staff across the organization to enhance problem-solving and improve operational efficiencies.
  • Establish and maintain positive relationships with third-party payers and clearinghouses to address billing discrepancies.
  • Assess the impact of new insurance contracts and changes in billing requirements.
  • Manage multiple priorities under tight deadlines, ensuring thorough follow-up and resolution.
  • Prepare various ad-hoc reports and analyses as needed.
  • Evaluate departmental processes for efficiency and accuracy.
  • Share responsibility for managing accounts receivable (A/R) effectively.
  • May supervise a team of claims adjudicators or billing specialists, ensuring accountability for achieving financial objectives.
Qualifications:
  • Bachelor's Degree in Business, Finance, or a related field, or equivalent work experience.
  • 3-5 years of experience in an analytical role within finance, claims management, or medical billing is preferred.
  • Familiarity with medical insurance payer guidelines and billing requirements is advantageous.
  • Demonstrated ability to communicate analytical results to management effectively.
  • Proficiency in Microsoft Office, with advanced skills in Microsoft Excel.
  • Strong analytical, organizational, and communication abilities.
  • Proven problem-solving and research skills.
Compensation & Benefits:
  • Hourly rate: $35-40
  • Comprehensive Medical, Dental, and Vision coverage
  • 401(k) plan with Company Match
  • Paid Sick and Vacation Days
  • Flexible Spending Account options
  • Life and Disability Insurance
  • Education Assistance programs
  • Employee Referral Program

We are dedicated to fostering a challenging work environment and maintaining our reputation for excellence. Our employees benefit from ongoing training and development opportunities across various disciplines.



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