Specialist – Revenue Management

The Revenue Management Specialist supports AR management, billing, collections, credit balance resolution, refund processing, charge review, claim edit resolution, payer variance research, and revenue integrity functions. Responsibilities may vary by department need but focus on ensuring patient and insurance accounts are managed accurately and timely.

This role requires strong medical billing knowledge, EOB interpretation, coding awareness, payer contract understanding, Excel skills, and the ability to work across departments to resolve revenue cycle issues. The specialist may also assist with credentialing, system table management, electronic remittance requirements, eligibility, claims agreements, vendor claim updates, and payer resubmissions.

### Key Responsibilities

* Research outstanding patient credit accounts
* Research outstanding insurance credit accounts
* Resolve AR management issues
* Update accounts to support accurate claim filing
* Process refunds and credit reversals
* Prepare government monthly credit reporting
* Review charge capture accuracy
* Resolve charge edits
* Post updates to AR systems
* Handle denials related to charge capture
* Update patient demographics
* Update insurance registration information
* Verify insurance information
* Consolidate duplicate guarantor or patient accounts
* Review Accounts Receivable reports
* Identify and report revenue trends
* Research payer variances
* Analyze contract modeling discrepancies
* Confirm expected reimbursement amounts
* Work with departments on revenue integrity issues
* Refile claims to appropriate payer sources
* Assist with payer and physician credentialing
* Support system table management
* Process electronic remittance agreements
* Support eligibility and claims agreements
* Process vendor claim updates, returns, and resubmissions

### Requirements

* High School Diploma or equivalent
* 4+ years medical office, medical billing, hospital billing, physician billing, collections, or coding experience
* Strong CPT knowledge
* Strong HCPCS knowledge
* Strong ICD-9/10 coding knowledge
* Ability to read insurance EOBs
* Understanding of remittance codes
* Understanding of remark codes
* Microsoft Excel proficiency
* Strong communication skills
* Ability to interact with multiple departments and management levels

### Preferred Qualifications

* In-depth payer billing knowledge
* Eligibility requirement knowledge
* CPC certification
* CPC-H certification
* CRCA certification
* CMIS certification
* RHIT certification
* Medicare billing experience
* Direct Data Entry experience
* High-volume acute care hospital billing experience
* UB-04 inpatient and outpatient claim billing knowledge
* Epic billing system experience
* Claim edit resolution experience
* RTP and payer rejection resolution experience
* Medicare regulation knowledge
* MSP guideline knowledge
* Condition code knowledge

### Phone Level Breakdown

* Payer follow-up: Low to Moderate
* Internal department communication: Moderate
* AR research: High
* EOB/remittance review: High
* Claim edits and denials: High
* Refund processing: High
* Patient interaction: Low

### Best Fit For

Candidates with experience in revenue cycle management, medical billing, hospital billing, accounts receivable, credit balance resolution, refund processing, denials management, claim edits, payer variance research, EOB review, UB-04 billing, Medicare billing, Epic billing, and healthcare reimbursement analysis.