• The Revenue Cycle Specialist is responsible for reviewing and processing claims in various stages of the revenue cycle in a timely and compliant manner • Monitor overall client performance, identify potential loss or delay in revenue to ensure maximized reimbursement for assigned clients • Initiate timely and proactive communication to payers to identify deficiencies and provide appropriate feedback to operational staff in order to resolve and prevent issues • Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and all other follow up on claims in accordance with compliance standards and payer and client specifications • Work independently to define problems, identify causes, and initiate steps necessary for resolution in a timely manner • Regularly meet, and effectively communicate with, Supervisor Claims Management, onshore and/or offshore team members to ensure highest level of reimbursement is achieved • Holistically approach client performance by utilizing big picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow though • Monitor and measure client performance outcomes in comparison to client commitments; identify barriers, seek and suggest solutions when desired outcomes are not achieved • Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness • Exhibit strong customer service skills to build and maintain internal and external relationships in order to best address client needs.

• Provides billing support to Patient Financial Services. • Performs payment posting to support revenue cycle operations. • Identifies denials for follow up and performs account follow up activities. • Updates information on accounts and organizes work in a timely manner. • Participates in department meetings and provides feedback to management.

• Performs retrospective coding review of denied charges for physician services. • Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing. • Make corrections to charges when necessary. • Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization. • Performs extensive follow-up to investigate and resolve payment denial trends. • Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation. • Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals. • Ensures denial reviews are conducted in a timely manner. • Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors. • Participates in annual and on-going mandatory compliance training. • Fulfills Continuing Education Units necessary to maintain certification status. • Assists in training current and new employees on the use of systems and departmental policies and procedures. • Performs other related duties as assigned.

• Coordinates, completes, and monitors the provider/facility payer credentialing process • Processes credentialing and re-credentialing applications for health care providers • Sends, reviews, and verifies credentialing applications • Loads and maintains provider information in an online credentialing database system • Tracks license and certification expirations for medical staff to ensure timely renewals • Handles and resolves inquiries regarding credentialing information, process, or status