A Revenue Cycle Specialist III (RCS III) acts as a senior-level expert in medical billing and collections, managing complex denials, insurance appeals, and high-dollar accounts to optimize cash flow. They frequently serve as subject matter experts (SMEs) supporting staff, auditing billing accuracy, and analyzing payer trends to ensure regulatory compliance and maximize reimbursement.
Key responsibilities include:
- Complex Denial Management & Appeals: Reviewing and resolving complicated, denied, or slow-pay claims by analyzing EOBs (Explanation of Benefits) and crafting detailed written appeals.
- Accounts Receivable Follow-Up: Researching and resolving aged, high-risk, or high-dollar accounts to ensure maximum reimbursement.
- Technical Expertise & Reporting: Utilizing EMR/practice management systems (e.g., Athena, Epic, Allscripts) to run, analyze, and report on key performance indicators (KPIs) to leadership.
- Subject Matter Expert (SME): Acting as a technical resource for junior staff, assisting in training, and providing cross-training in complex multi-specialty billing areas.
- Compliance & Process Improvement: Monitoring payer contracts and coding guidelines (ICD-10/CPT) to ensure compliance, while recommending process improvements for faster charge capture.
Requirements & Qualifications
- Senior-level experience in medical billing, collections, and revenue cycle management.
- Expertise in denial management and insurance appeals.
- Familiarity with EMR/practice management systems such as Athena, Epic, and Allscripts.
- Knowledge of ICD-10 and CPT coding guidelines.
- Strong analytical and reporting skills.
- Ability to train and mentor junior staff.
Location
Riverside, California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
1 week ago