Revenue Cycle Management Specialist - Billing

KPH Healthcare Services; Hoffman Estates (IL); On-site; USD 42,000 - 65,000; Full time

Job summary

KPH Healthcare Services is seeking a Revenue Cycle Management Specialist - Biller in Illinois. The role focuses on accurate and timely claim creation and submission for third-party payers, with emphasis on billing accuracy and issue resolution.

Responsibilities include submitting claims, verifying codes and amounts, following up on rejections, and communicating with patients on billing matters. The position requires 1–3 years in Home Infusion or Specialty Pharmacy billing and strong Excel skills.

Qualifications

• High school diploma or GED.
• 1–3 years of experience in home infusion or specialty pharmacy billing.
• Ability to read and interpret medical records for billing purposes.
• Proficient in CPT/HCPCS/ICD-10 coding.
• Knowledge of HIPAA and patient privacy requirements.
• Experience with pharmacy billing systems and MS Office.

Responsibilities

• Accurately prepare and submit claims for payment from all payers.
• Verify documentation aligns with prepared claims.
• Verify accuracy of billed codes and amounts.
• Resolve billing issues and resubmit claims as needed.
• Follow up on submitted claims and resolve rejections.
• Prepare and submit patient statements.
• Communicate billing issues to patients and assist with financial hardship applications.
• Maintain current and accurate records across departments.
• Support improvement initiatives for billing processes.
• Ensure compliance with laws and accreditation standards.
• Participate in surveys and performance improvement activities.
• Complete mandatory regulatory training.

Skills

Reading medical records

Mathematical calculations

Unit conversions

CPT/HCPCS/ICD-10

HIPAA compliance

Excel/Outlook

Billing systems

Attention to detail

Communication skills

Self-directed

Education

High school diploma or GED

Tools

CPR+

Wellsky

CareTend

Job description

Overview

Job Summary: The Revenue Cycle Management Specialist- Biller responsibility is to manage the process of the company's billing function including accurate and timely claim creation and submission.

Responsibilities

• Accurately prepare and submit claims for payment from all third-party payers in a timely manner.


• Verify documentation of supplied products align with prepared claim.


• Verify accuracy of billed codes and accuracy of billed and expected amounts.


• Support the resolution of billing issues such as claim resubmissions to all payers, changes in coverage, and claims


• Follow up on submitted claims and resolve rejected claims, including claim corrections, update payer ID, update patient insurance record, etc.


• Prepare and submit patient statements.


• Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about


• Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.


• Assist in the implementation of processes to measure, assess, and improve the performance of the billing department activities of the company.


• Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement \"best practices\" in all departmental


• Participate in surveys conducted by authorized inspection


• Participate in the company's Performance Improvement program as requested by the Performance Improvement


• Participate in company committees when


• Participate in in-service education programs provided by the company.


• Pursue continuing education programs appropriate to job


• Perform other duties as assigned by


• Complete all mandatory and regulatory training programs.


• Report any misconduct, suspicious or unethical activities to the Compliance


• Complies with accepted professional standards and practice.

Qualifications

Educational Requirements:

• High school diploma or GED

Experience:

• One to three years of experience in Home Infusion or Specialty Pharmacy billing.

Job Skill Requirements:

• Ability to read and interpret medical records for billing purposes.


• Competent in mathematic equations.


• Ability to compute unit conversions for drugs.


• Understanding of CPT, HCPCS, and ICD-10 codes


• Has excellent attention to detail and communication skills.


• Understanding of HIPAA compliance.


• Self-directed, has the ability to work with little supervision.


• Proficiency in Excel, Outlook, and all other office applications.


• Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)


• Familiar with billing requirements for various payers (Medicare, Medicaid, Commercial, etc.)


• Knowledge and experience submitting pharmacy and medical claims electronically or on paper.