Revenue Cycle Specialist

Edwards Electronic Processing, Inc.; Orlando (FL); On-site; USD 52,000 - 70,000; Full time

Benefits offered by this job

401(k) with company matching

Life insurance

Paid time off

Job summary

Edwards Electronic Processing (EEP) is a Orlando-based medical billing agency seeking a Revenue Cycle Specialist to manage full end-to-end revenue cycle on-site.

Responsibilities include claims submission, denial management, benefit verification, prior authorizations, AR follow-up, and patient billing, with emphasis on HIPAA compliance and accurate coding.

Qualifications

• 3+ years of hands-on medical billing or revenue cycle experience required.
• Experience with the full claim cycle in an RCM system.
• Experience billing commercial insurance, Medicare, and Medicaid.
• Strong understanding of CPT, ICD-10 codes, and modifiers.
• Familiarity with medical terminology, insurance, and benefits.
• Typing speed of 50+ WPM and proficiency with 10-key.
• Excellent verbal and written communication skills.
• Ability to work independently while contributing to a team.
• Therapy billing experience is a plus.

Responsibilities

• Claims submission, posting, denials and appeals processing.
• Verify benefits and eligibility (VOB) and track authorizations.
• AR follow-up and aging management with payers.
• Review patient invoices and communicate balances with patients.
• Research and resolve insurance and patient credit balances.

Skills

Medical billing

Revenue cycle

HIPAA

CPT/ICD-10 knowledge

Attention to detail

Typing speed 50 WPM

Communication skills

Independent worker

Job description

Company Description

Edwards Electronic Processing (EEP) is a medical billing agency based in Orlando, Florida, serving healthcare practices of all sizes for over 25 years. The organization is known for personalized service and high client satisfaction, with many clients maintaining long-term partnerships over decades. EEP has deep expertise in billing for pediatric therapy providers, including Physical, Speech, and Occupational Therapies, especially in the Central and South Florida area. EEP's sister company, TheraPlan, is a well-loved electronic health records company, and EEP lends its deep billing expertise to aid in the development of this impactful software. EEP values adaptability and collaboration, working closely with clients to meet varied billing needs.

Role Description

The Revenue Cycle Specialist is a full-time, on-site role based in Orlando, Florida. This role is responsible for managing the end-to-end revenue cycle, including claims submission, payment posting, denials and appeals, insurance verification, prior authorizations, AR follow-up, and patient billing. Daily tasks include reviewing patient accounts, verifying insurance coverage, ensuring accurate coding and documentation, and communicating with payers and providers to address billing issues. The specialist will analyze billing reports, identify trends impacting reimbursement, and recommend process improvements to optimize collections and reduce aging accounts receivable. This position also involves collaborating with internal team members to maintain compliance with payer guidelines and support a consistent, high-quality billing experience for clients.

Key Responsibilities (RCM)

• Claims Management: Clean, scrub, and submit electronic and paper claims to various insurance carriers.
• Denials & Appeals: Identify the cause of claim denials and prepare clinical and administrative appeals to secure payment. When necessary, contact insurance carriers to determine denial reasons or request claim reprocessing.
• Verification of Benefits (VOB): Verify patient insurance coverage, including deductibles, co-pays, benefits, and plan limitations.
• Prior Authorizations: At client request, obtain and track required authorizations and process approvals as they are received. Communicate promptly with clients when authorizations are denied.
• AR Follow-up: Monitor aging reports and consistently follow up with insurance carriers on outstanding and underpaid claims.
• Patient Invoicing: Review patient invoices for accuracy before sending. Communicate with patients and providers regarding patient balances.
• Payment Posting: Post electronic and manual remittances, handling denials, exceptions, and holds as needed.
• Insurance & Patient Credit Balances: Research insurance and patient credit balances and work to resolve them through client or insurance communication, voids, or replacement claims.

Key Responsibilities (Workstyle)

• Client Communication: Serve as a professional point of contact for provider offices, providing clear updates on claim status, answering questions, and providing excellent customer service.
• Compliance: Maintain strict adherence to HIPAA regulations and stay current with applicable ICD-10, CPT, and HCPCS coding guidelines.
• Team Support: Be a proactive and positive member of the team by assisting team members as needed or during absences.
• Task Management: Complete assigned work through our task management system and assist with other responsibilities needed to support the revenue cycle.

Qualifications:

• 3+ years of hands-on medical billing or revenue cycle experience required
• Experience working the full claim cycle in a revenue cycle management system (or at least many facets of it)
• Experience billing commercial insurance, Medicare, and Medicaid
• Strong understanding of CPT, ICD-10 codes, and appropriate use of modifiers
• Familiarity with medical terminology, insurance, and benefits
• Strong attention to detail and ability to manage multiple priorities
• Typing speed of 50+ WPM and proficiency with 10-key
• Excellent verbal and written communication skills
• Ability to work independently while contributing to a team-oriented environment
• Previous experience with therapy billing is a plus, but not required

What We Offer

• Full-time position
• Collaborative team-based work environment
• Opportunity to learn about all facets of the clinical revenue cycle
• 401(k) with company matching
• Life insurance
• Paid time off
• Making a difference for clinics and their pediatric patients

If you're an experienced billing professional who enjoys working through the details of the revenue cycle, solving problems, and providing excellent service to clients, we'd love to hear from you.