Revenue Cycle Specialist - Remote

Overview

This position is posted by Jobgether on behalf of Medical Guardian. We are currently looking for a Revenue Cycle Specialist in United States.

As a Revenue Cycle Specialist, you will take ownership of a dedicated portfolio of Medicaid payer accounts, ensuring accurate and timely reimbursement for essential healthcare services. You’ll be responsible for investigating claim discrepancies, addressing denials, and working collaboratively to maximize revenue. This remote role requires a detail-oriented and proactive professional with strong problem-solving skills and knowledge of payer-specific guidelines. If you're analytical, organized, and thrive in a deadline-driven environment, this is an opportunity to make a meaningful impact in a mission-oriented team.

In Short

• Manage a designated portfolio of Medicaid payers and serve as the primary point of contact for resolution.
• Conduct proactive follow-up on outstanding claims to secure timely reimbursement.
• Review, analyze, and appeal denied or underpaid claims in accordance with payer-specific rules and contract obligations.
• Identify and escalate patterns in denials or underpayments to management.
• Communicate with insurance companies via portals, phone, or written correspondence.
• Ensure all claim activity is documented accurately for auditing and tracking purposes.
• Submit corrected claims or reconsideration requests when necessary.
• Maintain compliance with payer timelines, authorization processes, and guidelines.
• Participate in a remote team environment with minimal patient interaction and limited phone work (mainly with care managers).

Requirements

• Detail-oriented and proactive professional.
• Strong problem-solving skills.
• Knowledge of payer-specific guidelines.
• Analytical and organized.
• Ability to thrive in a deadline-driven environment.

Benefits

• Opportunity to make a meaningful impact in a mission-oriented team.