Pediatrics Revenue Cycle Specialist – Claims & Denials

Colorado Psychiatric; Parker (CO); On-site; USD 55,000 - 75,000; Full time

Job summary

Mainstreet Pediatrics is a Parker, Colorado based independent pediatric practice seeking an experienced Medical Billing & Revenue Cycle Specialist to join the team in-house.

The role focuses on owning the revenue cycle from encounter through payment, working with insurers, payer portals, and our EHR to ensure timely payments and shrink aging A/R. Initially on-site with potential hybrid later, based on performance and needs.

Qualifications

• Previous professional medical billing and/or revenue cycle management experience.
• Strong understanding of the complete medical claims lifecycle.
• Experience working insurance A/R and resolving unpaid or incorrectly paid claims.
• Experience researching and resolving claim denials and rejections.
• Experience preparing corrected claims and payer appeals.
• Working knowledge of CPT, ICD-10, HCPCS codes, modifiers, and general medical billing rules.
• Ability to interpret EOBs and ERAs.
• Ability to identify potential underpayments and reimbursement discrepancies.
• Experience using insurance payer portals and communicating directly with payer representatives.
• Excellent organizational skills and attention to detail.
• Strong written and verbal communication skills.
• Ability to independently research problems and follow them through to resolution.
• Ability to manage multiple outstanding issues and prioritize claims based on age, value, and filing deadlines.

Responsibilities

• Review encounters and claims for accuracy and completeness prior to submission.
• Submit clean claims electronically and ensure claims are accepted by clearinghouses and payers.
• Identify and promptly resolve claim rejections.
• Monitor claims through the adjudication process rather than simply waiting for payment.
• Review EOBs and ERAs for appropriate payment, adjustments, denials, and patient responsibility.
• Identify insurance underpayments and pursue additional reimbursement when appropriate.
• Research and resolve denied claims.
• Prepare and submit corrected claims, reconsiderations, and formal payer appeals.
• Follow up aggressively and consistently on outstanding insurance accounts receivable.
• Monitor aging reports and prioritize claims requiring immediate action.
• Identify claims approaching payer timely-filing or appeal deadlines.
• Work directly with insurance companies, payer representatives, and provider relations departments to resolve outstanding claims.
• Maintain detailed documentation of payer communications and claim follow-up.
• Post and reconcile insurance payments, adjustments, and patient responsibility when necessary.
• Identify payer-specific billing requirements and recurring denial trends.
• Recognize potential credentialing, enrollment, or payer configuration problems affecting reimbursement and escal
• Assist with insurance eligibility, coordination-of-benefits, and payer-related patient account issues.
• Research discrepancies between expected reimbursement and actual payment.
• Help resolve patient billing questions when the underlying issue involves insurance processing or claim adjudication.
• Provide management with clear reporting regarding A/R, denials, outstanding claims, payer issues, and revenue-cycle trends.
• Identify systemic billing problems rather than addressing claims individually when a broader issue exists.
• Recommend and implement workflow improvements designed to reduce denials, accelerate payment, and improve overall revenue-cycle performance.

Skills

Billing experience

Revenue cycle knowledge

Accounts receivable

Denials resolution

EOB/ERA interpretation

CPT/ICD-10/HCPCS knowledge

Payer portals

Organizational skills

Communication skills

Problem-solving

Prioritization

Education

Medical billing/revenue cycle experience

Tools

eClinicalWorks

Job description

Mainstreet Pediatrics is a Parker, Colorado based independent pediatric practice seeking an experienced Medical Billing & Revenue Cycle Specialist to join the team in-house.

The role focuses on owning the revenue cycle from encounter through payment, working with insurers, payer portals, and our EHR to ensure timely payments and shrink aging A/R. Initially on-site with potential hybrid later, based on performance and needs.