Revenue Cycle Coverage Specialist

Care New England Health System; Warwick; On-site; GBP 25,000 - 35,000; Full time

Job summary

An established industry player in healthcare is seeking a Revenue Cycle Coverage Specialist to enhance their billing processes and ensure smooth claim submissions. This role is vital in identifying and resolving claim errors, verifying insurance details, and troubleshooting billing issues. The ideal candidate will possess strong attention to detail and problem-solving skills, contributing to optimal reimbursement and a seamless patient experience. Join a collaborative team where your contributions directly impact the efficiency of revenue cycle operations and patient satisfaction. If you're passionate about delivering high-quality service and improving processes, this opportunity is perfect for you.

Qualifications

• 1-3 years of customer service experience in healthcare or business required.
• Strong attention to detail and problem-solving skills are essential.

Responsibilities

• Ensure timely and seamless claim submission by capturing and updating billing information.
• Investigate and correct denials caused by inaccurate payor information.

Skills

Attention to Detail

Problem-Solving Skills

Customer Service

Communication Skills

Education

High School Diploma or Equivalent

Job description

The CNE Revenue Cycle Coverage Specialist is a key contributor to the success of the revenue cycle team, ensuring claims and billing processes run smoothly and efficiently. In this role the specialist takes ownership of identifying and resolving claim edits and charge review errors, verifying insurance and patient registration details, and troubleshooting denials tied to inaccurate payor information. Their attention to detail and problem-solving skills directly support optimal reimbursement and a seamless patient billing experience.

Duties and Responsibilities:

1. Accurately capture and update billing information to ensure timely and seamless claim submission.
2. Proactively identify and resolve claim edits, charge review errors, and billing issues tied to registration or insurance discrepancies.
3. Confirm insurance eligibility and coverage details to avoid delays in claim processing.
4. Investigate and correct denials caused by inaccurate or incomplete payor information.
5. Monitor trends in claim edits and denials, and share insights to drive continuous improvement.
6. Work collaboratively with payors, patients, and internal teams to gather missing information and expedite claim resolution.
7. Maintain thorough documentation and stay compliant with all timely filing requirements and regulatory standards.
8. Flag critical billing or insurance issues to leadership and contribute actionable solutions for process enhancements.
9. Support team success by pitching in where needed, fostering collaboration, and protecting patient confidentiality.
10. Take on additional tasks as needed to keep the revenue cycle running smoothly.
11. Manage priorities effectively, staying flexible and responsive to shifting workflows and department needs.
12. Consistently meet deadlines and performance expectations through organized, focused work habits.
13. Offer suggestions to improve systems, services, and tools that enhance overall efficiency.
14. Apply sound judgment when making decisions, relying on knowledge of policies and best practices.
15. Build strong relationships with both internal and external customers through proactive and attentive service.
16. Recognize the impact of customer interactions on organizational goals and uphold high service standards.
17. Follow established protocols and leverage available tools to deliver dependable support.
18. Communicate openly and effectively across departments and organizational levels.

Requirements:

1. Must possess a high school diploma or equivalent.
2. Minimum of 1-3 years of previous customer service experience in a healthcare or business environment required.