Revenue Cycle Specialist Lead

This position is remote, but candidate must reside in Hawai’i

As a Lead Revenue Cycle Specialist, you will play a crucial role in managing the revenue cycle operations of our healthcare facility, with a focus on medical billing front end and insurance collections. This position requires strong expertise in claims processing, insurance collections, and leadership skills.

Responsibilities:

Medical Billing Front End:

• Process 100 accounts per day for claims processing, focusing on Hospital/Acute billing

• Handle both electronic and paper claims submissions, ensuring accuracy and compliance.

• Manage a work queue comprising 75% corrections and front-end denials, including 277 rejections.

• Utilize payer portals for claim submissions and corrections.

• Address front-end denials promptly, ensuring timely resolution.

Insurance Collections:

• Handle 50 accounts per day for insurance collections, focusing on post-billing stages.

• Verify claim status and perform follow-up actions, utilizing payer portals effectively.

• Process deferrals and resubmissions, addressing back-end denials through thorough research and resolution.

• Collaborate with the Utilization Management team to address complex claims and payer issues.

• Utilize government payer experience, including Medicare and Medicaid, to navigate reimbursement processes effectively.

Requirements:

• Demonstrated experience in medical billing front end and insurance collections, with a strong understanding of Hospital/Acute billing processes.

• Proficiency in handling both electronic and paper claims submissions.

• Ability to manage high-volume work queues and prioritize tasks effectively.

• Experience with payer portals and claim status verification.

• Strong problem-solving skills and attention to detail, especially in resolving denials and rejections.

• Prior leadership experience in revenue cycle management.

• EPIC software, preferred not required

• Familiarity with government payers, including Medicare and Medicaid, is highly desirable.

• Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal teams and external stakeholders.

This position is remote, but candidate must reside in Hawai’i

Pay Details: $22.00 to $25.00 per hour

Search managed by: Joanna Calderon

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.