Revenue Cycle Specialist

• Reconcile and post all payments received
• Identify discrepancies and analyze issues to ensure timely payment posting
• Manage inventory and system alignment between Cotiviti and clients
• Reconcile data between different sources
• Post payments to collection accounts and reconcile them with posted bank transactions
• Coordinate with the AP department to issue refunds when needed
• Reconcile monthly bank statements with the cash posting database
• Post adjustment transactions to collection and client systems
• Perform cash application functions according to corporate and client requirements
• Access and interpret online systems to determine claim payments and accurately apply payments and adjustments
• Assist in determining the adjudication of refunds
• Prepare and record financial transactions for assigned accounts
• Ensure daily deposit reconciliation and maintain daily and monthly audit reporting
• Review and correct discrepancies in daily deposit totals
• Balance and reconcile bank deposits and communicate with internal and external customers
• Research and accurately distribute payments lacking invoice numbers or dates of service
• Identify the correct claim for payments using patient and date-of-service information
• Maintain knowledge of compliance and recovery laws regarding processing and recoupment
• Work with cross-functional teams

• 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

• Post and reconcile healthcare payments, including ERA/EFT, checks, and credit cards
• Research unapplied cash, discrepancies, adjustments, denials, and refunds
• Reconcile payments against deposits and billing records

• Reconcile and post all payments received
• Identify discrepancies and analyze issues to ensure timely payment posting
• Manage inventory and system alignment between Cotiviti and its clients
• Reconcile data between different sources
• Post payments to collection accounts and reconcile them with posted bank transactions
• Work with the AP department to issue refunds when needed
• Reconcile monthly bank statements with the cash posting database
• Post adjustment transactions to collection and client systems
• Perform cash application functions according to corporate and client requirements
• Access and understand online systems to determine how claims were paid and accurately apply payments and adjustments
• Assist in determining the adjudication of refunds
• Prepare and record financial transactions for assigned accounts
• Ensure daily deposit reconciliation and maintain daily and monthly audit reporting
• Reconcile daily deposit totals, review and correct discrepancies
• Balance and reconcile bank deposits and communicate with internal and external customers
• Research and distribute payments without apparent invoice numbers or dates of service
• Determine the correct claim for payments using valid patient and date-of-service information
• Maintain knowledge of compliance and recovery laws regarding processing and recoupment to ensure compliance with state laws

• Support the financial integrity of the organization through payment reconciliation, accounts receivable follow-up, refund and credit processing, payment posting reconciliation, reporting, auditing, and billing support
• Ensure accurate revenue cycle operations, timely issue resolution, and effective collaboration with internal teams, vendors, patients, and external partners
• Promote and practice the organization’s mission and values and follow its policies and procedures
• Maintain confidentiality regarding patient/client information in accordance with HIPAA, professional, and departmental standards
• Assist with RCM processes and process improvements
• Proactively maintain knowledge of billing systems and processes, including EMR workflows and Clearinghouse vendors
• Process credits and refunds accurately and efficiently and maintain records of credit/refund transactions
• Participate in monitoring claim status volumes and assist with auditing activities
• Follow up on denied, unpaid, or rejected claims and resolve billing issues
• Assist with month-end reporting and reconciliation of payments and disbursements
• Communicate with patients, healthcare providers, insurance companies, and third-party administrators regarding billing processes, inquiries, and discrepancies
• Respond to internal and external stakeholder inquiries regarding billing issues
• Coordinate and fulfill revenue cycle provision requests from R1 as needed

Revenue Cycle Management, RCM Specialist

• Perform moderate to complex recurring and daily revenue cycle functions
• Reconcile and post payments received and identify discrepancies
• Process invoices and manage large inventories
• Process electronic requests across multiple systems and platforms
• Monitor organizational processes for accuracy, timeliness, and compliance
• Track processes and prepare management reports on departmental quality and actions
• Implement procedural changes to improve performance and efficiency
• Resolve minor errors and limited-risk exceptions
• Assist with onboarding and new-hire training; mentor Specialists
• Collaborate with Specialists and Seniors to share knowledge, tools, and tips
• Post payments and adjustment transactions to recovery, collection, and client systems
• Work with Accounts Payable to issue refunds when needed
• Reconcile monthly bank statements with the cash posting database
• Perform cash application functions according to corporate and client requirements
• Research and correctly distribute payments lacking invoice numbers or service dates
• Prepare and record financial transactions for assigned accounts
• Ensure daily deposit reconciliation and maintain daily/monthly audit reporting
• Maintain compliance with recovery and recoupment laws
• Meet departmental productivity and quality standards
• Gather data, analyze problems, evaluate options, and implement solutions
• Work with clients, customers, and partners to assess needs, provide assistance, and resolve problems

Revenue Cycle Specialist 2 – Inventory Management, Invoicing

• Bill and follow up on professional claims accurately and timely to expedite patient and third-party payments
• Maintain and resolve an assigned group of patient accounts receivable
• Reduce outstanding account balances
• Process refunds when identified
• Communicate regularly with the clinical operations team to ensure regulatory billing requirements are met

Patient Account Specialist, Revenue Cycle

• Review, resolve, and process Air client claims throughout the revenue cycle in a timely, accurate, and compliant manner
• Monitor assigned client accounts and claim inventories for revenue risks, reimbursement delays, aging trends, and performance improvement opportunities
• Prioritize and resolve pending, rejected, denied, underpaid, stalled, and aged claims, including accounts over 120 days
• Manage claims across commercial insurance, TRICARE, workers’ compensation, VA, Medicare, Medicaid, and other government-funded programs
• Contact payers and use approved portals to verify claim status, eligibility, benefits, payment details, filing requirements, and required follow-up actions
• Obtain medical records and supporting documentation, engaging patients or authorized parties when appropriate
• Prepare and submit claim corrections, reconsiderations, and appeals, including verbal appeals when appropriate
• Research underpayments, overpayments, payment discrepancies, and remaining balances; prepare refund documentation when required
• Identify account issues and root causes, resolve issues within authority, and escalate complex or unresolved matters
• Monitor client outcomes against productivity, quality, turnaround-time, operating procedure, and service-level standards
• Communicate payer trends, recurring deficiencies, workflow barriers, client concerns, and improvement opportunities to operational and management teams
• Collaborate with onshore and offshore team members and cross-functional revenue cycle partners
• Maintain current knowledge of payer policies, prompt-payment requirements, regulatory changes, and Air client-specific procedures
• Deliver professional service and maintain constructive relationships with payers, clients, patients, leaders, and colleagues
• Perform other duties as assigned

• Prepare and submit physician and clinic claims to third party insurance carriers electronically or by hard copy billing
• Secure needed medical documentation required or requested by third party insurances
• Follow up with third party insurance carriers on unpaid claims until paid or only self-pay balance remains
• Process rejections by making accounts private and generating a letter of rejection to patients, or correct billing errors and resubmit claims
• Work with physician or medical record staff to ensure correct diagnosis/procedures are reported
• Ensure proper documentation and charge entry of patient charges
• Keep updated on billing and insurance changes
• Monitor claims for missing information and authorization/control numbers
• Support clinic mission, vision, values, standards, policies, procedures, confidentiality standards, and ethical behavior
• Maintain third party billing logs
• Ensure documentation complies with regulatory agency requirements and best practices