Healthcare Revenue Cycle Specialist

1 week ago


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

We are a prominent private medical practice focused on the diagnosis and treatment of retinal and vitreous diseases. Our organization is seeking a dedicated full-time Revenue Cycle Analyst to enhance our operational efficiency. This role will report directly to the Revenue Cycle Manager (RCM), who oversees the RCM team.

Key Responsibilities:
  • Analyze Accounts Receivable (AR) Aging reports to identify and resolve problematic claims.
  • Engage with insurance payers to address outstanding claims and ensure timely resolution.
  • Provide insights and recommendations to optimize claims processing.
  • Evaluate AR credit balances to ascertain refund amounts owed to payers and patients, initiating refunds and adjustments as necessary.
  • Support provider and practice credentialing and contracting processes.
  • Assist with payer audit requests related to claims.
  • Respond to various inquiries from payers, including requests for medical records and updates to provider directories.
  • Analyze denial trends and propose strategies to minimize future denials.
  • Complete 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.
  • Strong analytical and problem-solving skills to effectively address unpaid claims, including the appeal process.
  • Proficient in Excel for managing and summarizing extensive data sets (e.g., pivot tables, vlookups, conditional formulas).
  • Ability to work autonomously and efficiently.
  • Excellent communication and interpersonal skills.
Preferred Qualifications:
  • Experience in payer credentialing and contracting.
  • Comprehensive knowledge of full-cycle claims processing, including authorizations, eligibility, coding, and claims follow-up.
  • Familiarity with NextGen practice management software.


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