Revenue Cycle Specialist - Medicare

Full-time

Description

Overview of the Role

The Revenue Cycle Management (RCM) Specialist is responsible for managing key aspects of the revenue cycle process within Quest Health Solutions. While a third-party billing company handles initial billing functions, this role focuses on escalations, oversight, and specialized tasks to ensure accurate billing, effective denial management, and smooth coordination across departments. The RCM Specialist plays a vital role in maximizing revenue, supporting compliance, and enhancing overall operational efficiency.

Essential Duties and Responsibilities

Accounts Receivable (AR) & Billing

Handling AR tasks, including research and resolution of outstanding balances.

Conduct denials report reviews.

Manage write-off approvals.

Handle AR tasks related to denied or delayed claims.

Resupply Management Order Escalations

Manage RCM intake and order escalations involving AR and billing-related issues.

Medicare Appeals Oversight

Review Medicare appeals prepared by the billing company for accuracy.

Provide guidance and direction to the billing company on appeal content and strategy when needed.

Customer Service

Perform patient outreach to obtain updated information when required to resolve billing or order issues.

Support patients in understanding billing-related inquiries and coordinate resolutions with internal teams.

Process Improvement

Identify opportunities for process improvements within the revenue cycle to enhance efficiency, accuracy, and compliance.

Requirements

What You’ll Bring

DME & Medicare Billing Expertise: Previous experience in a revenue cycle management role with a strong focus on Durable Medical Equipment (DME). In-depth knowledge of Medicare billing processes, claim requirements, and LCD (Local Coverage Determination) guidelines, with the ability to review documentation for compliance.

Technical Knowledge: Familiarity with Brightree and core revenue cycle functions, including AR management, billing workflows, and denial resolution.

Problem-Solving Ability: Demonstrated capacity to research, analyze, and resolve complex billing issues and denials effectively and efficiently.

Communication Skills: Strong verbal and written communication skills to collaborate with internal teams, patients, physicians’ offices, and insurance providers.

Organizational Skills: Excellent organizational skills with the ability to manage multiple priorities, meet deadlines, and ensure timely resolution of escalations.

Benefits

Medical, Dental, and Vision Insurance

Life Insurance coverage

Paid time off and Holiday Pay

401K with company match option

Growth opportunities

Join a team where your work has real impact. Apply today and help transform the lives of people living with diabetes!