Revenue Cycle Specialist

Job Description

This is a remote position.

Job Highlights:

• Contract type: Independent Contractor
• Night Shift Schedule: Monday to Thursday - 8:45am to 5pm New York Time (8:45pm - 5am Manila Time)
• Friday - 8:45am to 3:45pm New York Time (8:45pm - 3:45am Manila Time)

Role Summary

The Revenue Cycle Specialist is responsible for managing the full revenue cycle process, from provider enrollment and prior authorizations through claims submission, reimbursement, and follow-up. This role ensures timely, accurate billing and payment while identifying and resolving issues that impact cash flow.

Description:

Provider Enrollment

• Manage provider enrollments and re-credentialing with commercial and government payers
• Track enrollment status and follow up with payers as needed
• Maintain accurate provider and payer records

Prior Authorizations

• Obtain prior authorizations based on payer requirements
• Verify eligibility and benefits prior to services
• Communicate authorization approvals, denials, and requirements to internal teams

Claims Submission & Billing

• Review claims for accuracy and completeness prior to submission
• Submit electronic and paper claims using billing software
• Audit documentation to ensure services billed are supported
• Address and correct rejected claims in a timely manner

AR / Reimbursement / Follow-Up

• Post payments, ERAs, and EOBs accurately
• Follow up on unpaid, underpaid, and no-response claims
• Investigate and resolve denials, including resubmissions and appeals
• Track outstanding balances and identify trends impacting reimbursement

Reporting & Collaboration

• Identify recurring issues and recommend process improvements
• Provide regular updates on AR status, denials, and enrollment issues
• Attend team meetings and complete assigned follow-ups

Knowledge/skills/abilities:

• Strong attention to detail and organizational skills.
• Ability to plan, prioritize, and meet deadlines in a fast-paced environment.
• Advanced reading comprehension and ability to synthesize complex data into actionable processes.
• Willingness to learn, grow, and adapt to evolving processes.
• Genuine commitment to client success, beyond task completion. Focuses on driving results that add optimum value, not just checking boxes.
• Excellent communication skills—both written and verbal—with clarity and conciseness.
• Collaborative team player
• Demonstrates initiative and accountability to achieve high-quality results.
• Demonstrates persistence and professionalism in working with payors to achieve effective outcomes.

Core Values:

We hire/fire/promote based on these core values + job-specific performance.

1. Respectful of our unique cultural environment

2. Absolute confidentiality

3. Embracing teamwork

4. Loyal behavior and positive attitude

5. Accountability

6. Pro activeness

7. Thoroughness

8. Focused on results

9. Inspired to learn and grow constantly

10. Devoted to providing top-tier services to our clients through the companys "Unique Service Oriented Philosophies"

Requirements

• 2-year college degree
• 2 years related experience
• Experience with Smartsheet, Outlook, and other cloud-based project management or tracking tools preferred
• US Healthcare experience a plus but not required

Benefits

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Steady freelance job
• Profit sharing incentive
• Paid time off
• Holiday pay
• Annual Performance and Raise Evaluation
• Quarterly Perfect Attendance Incentive
• HMO
• BruntWork Loan Assistance

Please note that since this is a permanent work-from-home position and an “Independent Contractor” arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process.