Revenue Cycle Management Specialist

This role will be responsible for providing top-notch billing services while ensuring accuracy and efficiency in managing medical claims. This individual would report to the Revenue Cycle Manager. There will be a strong focus on reviewing data to develop insights on key gaps and trends, along with communication with colleagues and external stakeholders. We are looking for a detail oriented and highly organized colleague. This individual must be able to manage multiple priorities and have flexibility to wear multiple hats at our high-growth company. We want someone who will thrive in a fast-paced environment with a willingness to learn and grow. We also want someone who will be an excellent team player and deliver great service to colleagues. Our providers and other staff are based all over the United States, so we are looking for someone who has the flexibility to communicate effectively – verbally and in writing – with colleagues around the country. Key Responsibilities: Prepare and submit billing data and medical claims to insurance companies, ensuring accurate coding. Ensure the patient’s medical information is accurate and up to date. Prepare bills, invoices, and document amounts due for medical procedures and services. Post payments to the system, review Electronic Remittance Advice (ERA) for accuracy, and alert the AR follow-up team of any denials. Report trends in denied claims or payment discrepancies to management. Communication with colleagues and health plan staff to address issues and concerns- for example, troubleshooting denials, takebacks, and underpayments. Issue Analysis and Resolution: Analyze Electronic Remittance Advice (ERA) to resolve billing issues. Use critical thinking and problem-solving skills to address patient inquiries. Provide clear explanations of insurance claims and escalate complex issues as needed . Work queue Reviews: Review Open Work queue in Athena to ensure accounts are appropriately worked in conjunction with the billing cycle. Review Correspondence Open Task Work queue for proper assignment and follow-up. Review and manage Hold Bill/Alert Open Work queue for incomplete registrations . Required Qualifications: 2 years of experience in medical billing or a similar role. Solid understanding of billing software and electronic medical records (EMR), experience with Athena is a plus. Ability to multitask and manage time effectively in a fast-paced environment. A knowledge of ICD-10, CPT, and HCPCS codes. Associate degree or high school diploma. Preferred Qualifications: Experience with Athena or similar medical billing platforms. Experience with Salesforce. Proven experience in customer service, preferably in healthcare or financial settings. Proficient in Microsoft Office, especially Excel. Knowledge, Skills & Abilities: Self-starter, with high energy but also flexibility to shift directions quickly as the business requires it. Strong analytical and problem-solving skills Can effectively multitask across many different tasks to ensure high-priority tasks are completed on-time. Ability to work independently and in a highly virtual environment, with colleagues all over the country. Strong interpersonal skills to build relationships at multiple levels inside the company and as well with external vendors or clients. Open and accepting of suggestions, feedback, and new ideas. Excellent written and oral communication skills. Strong work ethic and a willingness to adhere to deadlines. Upward Health Benefits Upward Health Core Values Upward Health YouTube Channel