Revenue Cycle Claims & Denials Specialist

Phaxis; Charlotte (NC); Sur place; USD 52 000 - 70 000; Plein temps

Résumé du poste

Phaxis is seeking an experienced Revenue Cycle Account Reimbursement Specialist II to support our healthcare client’s revenue cycle. The role focuses on resolving complex insurance claims, analyzing denial trends, submitting appeals, and ensuring timely reimbursement.

The ideal candidate will bring strong medical billing knowledge, understand payer requirements, and collaborate with clinical and revenue cycle teams to optimize billing and collections. Mon-Fri, 8a-5p, onsite in Charlotte, NC.

Qualifications

• Three years or more of complex claims follow-up experience in a physician practice, hospital, ambulatory surgery center, or centralized medical billing office.
• Knowledge of commercial insurance, HMO/PPO, Medicare, Medicaid, and payer reimbursement guidelines.
• Experience reviewing denials and preparing claim appeals and reconsiderations.
• Ability to interpret payer explanations of benefits.
• Familiarity with medical terminology, ICD-10, and CPT codes.
• Strong organizational and time-management skills.
• Excellent verbal communication and customer-service skills.
• Proficiency with Microsoft Word and Excel.

Responsabilités

• Serve as a billing resource for assigned departments, answering questions related to payer requirements, denials, and patient accounts.
• Follow up on unpaid and underpaid insurance claims to support timely collection.
• Research claim issues and complete corrections, reconsiderations, and appeals.
• Review and interpret explanations of benefits to ensure claims and payments are reconciled correctly.
• Identify trends involving denials, underpayments, and overpayments.
• Collaborate with coding, charge capture, insurance verification, and reimbursement teams to resolve billing issues.
• Recommend process improvements to strengthen revenue cycle performance and reduce denials.
• Coordinate medical-record requests and process insurance and patient correspondence.

Connaissances

Complex claims follow-up

Payer requirements

Denials analysis

Appeals and reconsiderations

Time management

Verbal communication

Microsoft Word & Excel

Formation

High school diploma or equivalent

Associate degree in business, healthcare administration, or related field

Outils

AthenaHealth

Description du poste

Phaxis is seeking an experienced Revenue Cycle Account Reimbursement Specialist II to support our healthcare client’s revenue cycle. The role focuses on resolving complex insurance claims, analyzing denial trends, submitting appeals, and ensuring timely reimbursement.

The ideal candidate will bring strong medical billing knowledge, understand payer requirements, and collaborate with clinical and revenue cycle teams to optimize billing and collections. Mon-Fri, 8a-5p, onsite in Charlotte, NC.