Revenue Cycle Specialist

Position Overview
We're seeking a detail-oriented Revenue Cycle Specialist to manage complex insurance claims and ensure optimal revenue collection for our healthcare practice. Working remotely, you'll play a critical role in our financial operations by navigating the intricacies of medical billing across multiple payer types and resolving challenging reimbursement issues.

Remote Work Requirements: Dedicated workspace with minimal distractions and high-speed internet (minimum 25 Mbps download / 10 Mbps upload). What You'll Do
Core Responsibilities
Claims Management & Collections

• Process and follow up on complex insurance claims from workers' compensation, commercial insurers, managed care organizations, federal and state agencies, and third-party payers
• Ensure timely filing and collection according to established policies and industry best practices
• Monitor aging reports and work assigned claims to resolution

Coding & Compliance

• Review and validate CPT and ICD-10 codes using Medicare Guidelines, CCI edits, AAOS standards, and medical coding software
• Apply payer-specific billing rules and modifiers correctly across multiple insurance carriers
• Stay current with orthopedic coding updates through newsletters, alerts, webinars, and continuing education

Denial Management & Appeals

• Research, analyze, and appeal claim denials and underpayments
• Interpret EOBs, payer contracts, and fee schedules to identify payment discrepancies
• Apply appropriate adjustments, write-offs, and discounts per established guidelines
• Identify patterns and recommend process improvements to reduce future denials

Documentation & Communication

• Accurately document all actions, conversations, and patient data in the practice management system
• Collaborate with physicians, non-physician practitioners, and business office staff to resolve data issues
• Handle confidential patient information with professionalism and discretion
• Respond to patient billing inquiries via phone with clarity and empathy

Patient Support

• Answer inbound calls daily, assisting patients with billing questions, payment processing, and insurance verification
• Resolve complex patient inquiries escalated through the business office phone queue
• Provide exceptional customer service while managing high call volumes

Team Collaboration

• Support colleagues in resolving challenging payer or patient issues
• Report regularly to Business Office Supervisor and Director on billing matters
• Report to office location as needed for meetings or special projects
• Contribute to a culture of continuous improvement and revenue optimization

What You Bring
Required Qualifications

• Education: High school diploma or equivalent
• Experience: Minimum 2 years in healthcare billing or administrative support
• Technical Skills: Proficiency with Microsoft Office, practice management systems, and electronic health records
• Knowledge Base: Understanding of posting procedures, Medicare billing guidelines, CCI edits, modifiers, CPT and ICD-10 coding

Preferred Qualifications

• Experience with specialty practice billing (orthopedics strongly preferred)
• Familiarity with payer-specific billing rules and edit systems
• Medical billing, coding, or healthcare administration certification or coursework
• Previous remote work experience in healthcare revenue cycle

Essential Competencies
Technical Expertise

• Knowledge of Medicare, Medicaid, HMO, and commercial payer guidelines
• Understanding of multiple procedure bundling, surgical billing (surgeons, assistant surgeons, PA/ARNP surgical assist)
• Ability to interpret contracts, contractual adjustments, and multiple surgery discounts
• Skill in identifying improper claim payments and taking corrective action

Professional Skills

• Self-motivated with ability to work independently and manage time effectively
• Exceptional attention to detail and accuracy
• Strong written and verbal communication skills with proper grammar and spelling
• Excellent organizational and planning abilities
• Critical thinking and problem-solving mindset focused on efficiency and effectiveness
• Ability to maintain strict confidentiality of patient and personnel information

Personal Attributes

• Comfortable learning and adapting to new digital tools and systems
• Thrives in fast-paced, high-volume environments
• Customer service-oriented with strong interpersonal skills
• Able to multitask while maintaining quality and accuracy
• Resilient under pressure and flexible with occasional irregular hours to meet deadlines

Physical Requirements
This position requires extended periods of sitting and computer work. Must have eye-hand coordination and manual dexterity to operate keyboard, telephone, calculator, and standard office equipment. Normal range of hearing and vision necessary for communication and documentation. Ability to work under deadline pressure and maintain focus during peak workload periods.
 

Vaco by Highspring values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply.

EEO Notice

Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law.

Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact HR@ .

Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal .

By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.

Privacy Notice

Vaco by Highspring and its parents, affiliates, and subsidiaries ( we, our, or Vaco by Highspring ) respects your privacy and are committed to providing transparent notice of our policies.

• California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here .
• Virginia residents may access our state specific policies here .
• Residents of all other states may access our policies here .
• Canadian residents may access our policies in English here and in French here .
• Residents of countries governed by GDPR may access our policies here .

Pay Transparency Notice

Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:

• the individual's skill sets, experience and training;
• licensure and certification requirements;
• office location and other geographic considerations;
• other business and organizational needs.

With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.

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