Revenue Cycle Specialist (Denials and Collections)

Responsibilities:

• Own rejections, denials, and denied claims workflows from identification through resolution, including daily monitoring of ERA activity.
• Drive improvements in Net Collection Rate and payer turnaround times by managing reprocessing timelines and ensuring timely claim resubmission.
• Work denied, underpaid, and unpaid claims through direct payer portal navigation, phone calls, and written appeals.

Required Skills and Experience:

• At least 3 years of experience in healthcare billing, collections, denials, or revenue cycle management.
• Strong understanding of denials, rejections, EOBs, ERAs, and claims reprocessing workflows with commercial and government payers.
• Excellent attention to detail and organizational skills, with the ability to manage multiple priorities in a fast-paced environment.

Collaboration and Process:

• Investigate root causes of denials and coordinate corrective actions across billing, credentialing, clinical, and operations teams.
• Track trends in denials by payer and issue type, and proactively escalate high-risk or aging items.
• Support process improvement initiatives to reduce future denials and revenue leakage, maintaining accurate documentation.