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• achelor’s degree in healthcare administration, business, or related field (preferred).

• Minimum 3 years of experience in revenue cycle management or medical billing.

• Solid understanding of medical terminology, coding (ICD-10, CPT, HCPCS), and reimbursement models (FFS, capitated, etc.).

• Proficiency with billing software and EHRs (e.g., Athena, eClinicalWorks, Kareo, AdvancedMD, etc.).

• Familiarity with CMS guidelines and major insurance carriers (Medicare, Medicaid, BCBS, Aetna, UHC, etc.).

• Strong analytical, organizational, and communication skills.

• Ability to work independently and manage multiple tasks with tight deadlines.

Manage the entire revenue cycle process including patient eligibility, charge entry, claim submission, payment posting, denial management, and collections.

• Verify insurance eligibility and benefits prior to service.

• Ensure accurate and timely claim submission to insurance payers.

• Review rejections and denials and take appropriate action to resubmit or appeal.

• Analyze EOBs and remittance advices to identify payment trends, underpayments, or non-payments.

• Collaborate with coding and billing teams to ensure proper CPT/ICD coding and documentation compliance.

• Track and report key performance indicators (KPIs) including DSO, collection rates, denial rates, and AR aging.

• Communicate with payers, providers, and patients to resolve issues affecting reimbursement.

• Stay up to date with payer rules, industry changes, and HIPAA regulations.

• Recommend process improvements to reduce denials and improve cash flow.

Preferred Qualifications:

• Certified Revenue Cycle Specialist (CRCS) or Certified Professional Biller (CPB) is a plus.

• Experience in specialty practices (e.g., urgent care, primary care, surgery, etc.) is an advantage.

• Bilingual (English and [Insert Language]) preferred but not required.