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Revenue Cycle Specialist
EMS Management & Consultants, Inc.. Review and process claims through various stages of the revenue cycle in a timely and compliant manner .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing health insurance claims and denials, with a strong understanding of HIPAA regulations and payer requirements. Capable of analyzing client performance and implementing solutions to enhance workflows and maximize reimbursement.
Highest-signal resume keywords
Health Insurance Claims ProcessingHIPAA Regulations UnderstandingCritical Thinking and Analytical SkillsMicrosoft Office ProficiencyEMS Billing Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingDenials ManagementMedical BillingRevenue Cycle ManagementCompliance Adherence
Soft Skills
Organizational SkillsMultitasking AbilityAttention to DetailAdaptabilityCommunication Skills
Tools & Technologies
EMS|MC Billing SoftwareMicrosoft Office
Industry Keywords
MedicareMedicaidInsuranceTertiary Payment MethodsClient Performance Analysis
About the role
Key responsibilities & impact- Review and process claims through various stages of the revenue cycle in a timely and compliant manner
- Monitor client performance and identify potential revenue loss or delays to maximize reimbursement
- Suggest solutions to improve client performance, workflows, processes, and outcomes
- Provide proactive feedback regarding client performance, industry changes, payer regulations, and concerns
- Communicate with payers to identify deficiencies and provide feedback to operational staff
- Prioritize, process, and delegate correspondence, rejections, denials, appeals, static claims, and other claim follow-up
- Determine the appropriate next action for each claim
- Define problems, identify causes, and independently initiate and complete resolutions
- Meet and communicate with Claims Management supervisors and onshore/offshore team members
- Ensure effective work prioritization and adherence to standard operating procedures and vendor SLAs
- Monitor and measure client performance against commitments and address barriers to desired outcomes
- Stay current on industry changes and regulations
- Build and maintain internal and external relationships to address client needs
- Present client performance analysis as directed
- Serve as backup to other team members
- Perform other duties as assigned
Requirements
What you’ll need- High School Diploma
- At least 1–2 years of experience processing health insurance claims and/or denials or other healthcare accounts receivable experience, or 1–2 years medical billing experience, or at least 1 year EMS billing experience
- Ability to utilize big-picture analysis, critical and lean thinking, innovation, curiosity, tenacity, and consistent and timely follow-through
- Ability to organize, prioritize, and multitask
- Ability to learn, understand, and work within specific compliance, client, and payer requirements
- Commitment to continuous improvement
- Understanding of applicable HIPAA regulations, Medicare, Medicaid, insurance, liability, and tertiary payment methods
- Willingness and ability to adapt to changes in work environment, procedures, priorities, and job duties
- Ability to function within a cross-functional team setting and independently
- Strong critical thinking, analytical skills, and attention to detail
- Proficiency in Microsoft Office programs
- Proficiency in English for job-related communication
- Preferred: prior EMS billing and/or denials experience
- Preferred: proficiency in EMS|MC billing software
- Authorized to work in the United States now and in the future; no current or future visa sponsorship
Benefits
Comp & perks- Discretionary bonus plan
- Comprehensive benefit package
- Retirement plan
- Health coverage
- Paid time off
- EMS|MC-provided computer, monitor, keyboard, mouse, and headset
- Reasonable accommodations for qualified individuals with disabilities