Revenue Cycle Specialist

Revenue Cycle Specialist

Status: Full-Time, Non-Exempt

Pay Range: $21.00 – $25.00 per hour

Schedule: Onsite at our Home Office (Louisville, KY)

Hours: Monday–Friday, 8:30 AM–5:00 PM

Position Summary

The Revenue Cycle Specialist provides essential support in monitoring accounts receivable (AR), billing accuracy, and reimbursement performance across both pharmacy and medical claims. This role assists with KPI tracking, denial trending, and ensuring compliance with payer rules and 340B requirements.

Working closely with Billing/RCM and Finance, the Specialist prepares reports, verifies data accuracy, and supports initiatives that improve claim outcomes and reduce avoidable denials.

This is a entry to early mid- level role ideal for candidates eager to grow their knowledge of pharmacy and medical billing in a fast-paced, supportive healthcare environment.

This position reports to the Director of Finance.

Essential Functions

Accounts Receivable & Billing Support

• Monitor AR aging and identify past-due claims.
• Review and verify billing data for accuracy.
• Assist with cash posting and payment reconciliation.

Denials & Claim Trending

• Assist in reviewing payer denials and documenting denial reasons.
• Follow up on aged AR and denials to ensure resolution while reducing write-offs.
• Prepare reports summarizing top denial trends for leadership review.

Pharmacy & 340B Program Support

• Assist with reconciliation of 340B contract pharmacy data.
• Track pharmacy claim rejections (e.g., formulary issues, DIR fees).
• Verify NDC/J-code alignment and escalate discrepancies.

Reporting & Data Support

• Prepare weekly and monthly AR and denial trend reports.
• Support KPI dashboard maintenance for leadership.
• Perform basic Excel analysis (sorting, pivot tables, VLOOKUPs).

Collaboration & Compliance

• Communicate professionally with payers, providers, and internal teams.
• Maintain HIPAA and 340B program compliance.
• Escalate complex issues to Billing/Finance leadership.

Qualifications — Education & Experience

Required

• High school diploma or GED; Associate's or Bachelor's degree preferred.
• 1–2 years of experience in healthcare billing, AR, reimbursement, or related customer service role.
• Basic understanding of medical billing forms (CMS-1500, UB-04) and/or pharmacy claims (NCPDP).
• Proficiency in Microsoft Excel (pivot tables, VLOOKUP) and ability to learn billing systems.
• Strong attention to detail, accuracy, and data verification.

Preferred

• Experience in pharmacy or 340B program environments.
• Exposure to EMR/RCM systems (Epic, PioneerRx, FrameworkLTC, etc.).
• Familiarity with payer rules, claim edits, and denial management.

Knowledge, Skills, and Abilities

• Understanding of revenue cycle processes from claim submission to final payment.
• Strong communication and interpersonal skills; able to explain data clearly.
• Proficient data entry and basic analysis skills; BI tool exposure (Power BI) preferred but not required.
• Ability to identify and correct errors related to NDCs, J-codes, modifiers, and other claim details.
• Ability to read and apply payer contracts, CMS guidelines, NCPDP standards, and 340B rules.
• Experience with commercial, Medicare, and Medicaid claims.
• Strong judgment and problem-solving skills related to AR reconciliation and denial resolution.
• High attention to detail and commitment to accuracy and compliance.
• Collaborative working style with Finance, Billing/RCM, Pharmacy Operations, and external payer/provider partners.

Physical Requirements

• Must be able to stand, walk, sit, talk, and hear regularly.
• Use of hands for office equipment operations.
• Occasional lifting/moving up to 30 pounds.
• Vision requirements include close, distance, and peripheral vision with ability to adjust focus.