Revenue Cycle Specialist

Key Responsibilities

• Prepare, review, and submit accurate Auto/PIP and commercial health insurance claims.
• Perform timely insurance accounts receivable follow-up and resolve outstanding balances.
• Investigate and correct claim denials, rejections, underpayments, and payment discrepancies.
• Prepare and submit corrected claims, reconsiderations, and appeals as appropriate.
• Review insurance benefits, coverage limitations, deductibles, copayments, coinsurance, and authorization requirements.
• Monitor Florida PIP benefits, payment limitations, and exhaustion of benefits.
• Review EOBs and ERAs to identify payment discrepancies.
• Post and reconcile insurance payments, adjustments, and patient payments as assigned.
• Assist with attorney-related accounts, including requests for itemized statements and billing documentation.
• Maintain accurate patient insurance information and billing records within the practice management system.
• Identify and communicate billing discrepancies, recurring payer issues, and potential reimbursement concerns.
• Collaborate with clinical and administrative staff to resolve billing-related issues.
• Complete additional revenue cycle and billing assignments as directed by the Revenue Cycle Manager.

Required Qualifications

• Minimum of 3–5 years of hands-on medical billing experience, with a strong preference for 5+ years.
• Demonstrated experience with Florida Auto/PIP billing and commercial health insurance billing.
• Strong knowledge of medical claims processing, insurance reimbursement, denials, appeals, and accounts receivable follow-up.
• Understanding of CPT, ICD-10-CM, modifiers, and payer-specific billing requirements.
• Experience interpreting EOBs, ERAs, insurance fee schedules, and reimbursement discrepancies.
• Proficiency with EHR and practice management systems.
• Excellent organizational skills, attention to detail, and ability to manage competing priorities.
• Strong written and verbal communication skills.
• Ability to research, troubleshoot, and resolve billing issues independently.

Preferred Qualifications

• Previous billing experience in chiropractic or a multidisciplinary healthcare practice.
• Familiarity with Florida PIP reimbursement requirements, attorney-related claims, and letters of protection.
• Experience working with Medicare, Medicare Advantage, and commercial insurance plans.
• Medical billing or coding certification (CPC, CPB, or equivalent).