Sr. Revenue Cycle Billing Specialist (Remote, Remote, US)
# Sr. Revenue Cycle Billing Specialist (Remote, Remote, US) **firstsourc** · United States · `Remote` · `Full Time` 💼 **Уровень роли:** `Senior` 🕒 **Статус:** *Опубликовано: сегодня* · *Источник: Himalayas (JSON API)* --- ### Top Skills & Match 🎯 **Ключевой стек роли:** `[Revenue-Cycle-Management]` `[Medical-Billing]` `[Healthcare-Billing]` `[Denial-Management]` `[Billing-Specialist]` `[Senior-Medical-Billing-Analyst]` `[Senior-Healthcare-Billing-Coordinator]` `[Senior-Medical-Billing-And-Payment-Coordinator]` `[Remote-Billing-Coordinator]` --- ### About the Role Role Description The Revenue Cycle Denials Representative is responsible for managing and resolving denied Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role identifies root causes of denials, executes appeals and corrective actions, and collaborates with internal teams to prevent future denials. The ideal candidate has hands-on experience with CARC/RARC denial codes, Epic denial work queues, and payer-specific appeal requirements across Medicare, Medicaid, and commercial payers. Roles & Responsibilities Denial Review & Resolution – PB & HB - Review and analyze denied PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims to determine root causes and appropriate resolution strategies. - Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim. - Work claims across all top denial categories including, but not limited to: No Authorization, Timely Filing, Coordination of Benefits (COB), Medical Necessity, Additional Documentation Requests (ADR), Bundling (NCCI edits), and Duplicate Claims. - Interpret CARC and RARC codes on 835 ERA / EOB remittance data for both PB and HB claims to determine the correct resolution path. - Understand when claim corrections, rebilling (837P or 837I), or void-and-replace actions are appropriate. - Escalate claims with payers for resolution when processing is inaccurate or delayed. Appeals & Reconsiderations - Prepare and submit appeals and reconsideration requests in compliance with payer-specific guidelines and deadlines for both PB and HB denied claims. - Attach appropriate clinical documentation, medical records, authorization references, and justification letters to support appeal submissions. - Meet appeal deadlines for Medicare, Medicaid, and commercial payers in accordance with payer-specific requirements. Trend Identification & Prevention - Identify denial trends across PB and HB claim types and collaborate with coding, clinical, and billing teams to implement corrective actions. - Monitor payer policy and regulatory changes (Medicare LCDs/NCDs, Arkansas Medicaid updates) to proactively prevent denials. - Assist in developing best practices and training materials for PB and HB denial management and prevention. Payer & System Knowledge - Navigate Epic denial and underpayment work queues for both HB and PB modules; document all denial actions and resolutions. - Utilize payer portals (Availity, Arkansas DHS, Medicare.gov, and commercial payer sites) to research denial reasons and submit appeals. - Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations. Compliance & Documentation - Maintain thorough documentation of denial reasons, appeal actions, and resolutions in Epic. - Ensure compliance with federal, state, and payer regulations as well as hospital and physician practice policies. - Communicate effectively with insurance representatives and internal leaders to expedite resolution and improve processes. - Always maintain confidentiality of patient and account information (HIPAA). - Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct. - Maintain awareness of and actively participate in the Corporate Compliance Program. - Maintain a confidential and orderly remote work area. - Meet specified goals and objectives assigned by management and/or the Client. - Assist with other projects as assigned by management. Expected / Key Results - Deliver high levels of client and patient satisfaction (CSAT) - Achieve quality scores per defined process standards - Deliver defined process-specific metrics (e.g., denial resolution rate, overturn rate, appeal success rate) - Adherence to regulatory compliance requirements - Schedule adherence Preferred Educational Qualifications - High school diploma or equivalent required - Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred - CPC, CPMA, CRCR, or CHFP certification a plus Preferred Work Experience - 2+ years of experience in healthcare revenue cycle, denial management, or claims resolution - Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) denials - Prior experience with Epic denial work queues strongly preferred - Familiarity with Medicaid, Medicare, and commercial payers preferred - Experience interpreting CARC/RARC codes and 835 ERA / EOB remittance data - Knowledge of NCCI edits, LCD/NCD policies, and authorization/pre-certification workflows Competencies & Skills - Strong knowledge of PB and HB denial workflows, appeal processes, and payer-specific requirements - Proficiency with Epic (HB and/or PB modules, denial work queues, claim correction, void-and-replace, and rebilling) - Solid understanding of CARC/RARC denial reason codes and how to act on them for PB and HB claims - Ability to read and interpret 835 ERA / EOB remittance advice for both PB and HB claims - Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites - Competent in working and communicating effectively with payers, patients, colleagues, and management – both in-person and via remote virtual platforms - Consistently maintains a courteous and professional demeanor - Self-motivated with the ability to stay focused and productive with minimal supervision - Proactive initiative and creative problem-solving in carrying out job responsibilities - Ability to prioritize multiple tasks through effective time management and organizational skills - Proficiency in PC operations; ability to type at a rate of 30–40 words per minute Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off. Not Accepting Referrals Originally posted on Himalayas
- Revenue-Cycle-Management
- Medical-Billing
- Healthcare-Billing
- Denial-Management
- Billing-Specialist
- Senior-Medical-Billing-Analyst
- Senior-Healthcare-Billing-Coordinator
- Senior-Medical-Billing-And-Payment-Coordinator
- Remote-Billing-Coordinator
Наблюдалась 2026-10-02, впервые 2026-10-02, источник — Himalayas (JSON API).