Revenue Cycle Specialist

Medical Guardian; United States; Remote; USD 25,003 - 35,610; Full time

Benefits offered by this job

Health Care Plan (Medical, Dental & Vision)

Paid Time Off (Vacation & Public Holidays)

Short Term & Long Term Disability

Retirement Plan (401k)

Job summary

A healthcare technology company is seeking a seasoned Revenue Cycle Specialist to manage Medicaid payer accounts and ensure timely reimbursement for healthcare services. This fully remote role involves critical tasks such as claim follow-up and denial resolution, making strong analytical and communication skills essential. The specialist will serve as the primary contact for assigned payer accounts, emphasizing self-starter capabilities in a remote work environment. Candidates must have at least 2 years of experience in medical billing or revenue cycle management.

Qualifications

• 2+ years of experience in medical billing or revenue cycle management, focusing on insurance follow-up.
• Must be legally authorized to work in the United States.
• Proficient in Microsoft Office applications.

Responsibilities

• Manage a defined book of insurance payers.
• Conduct follow-up on outstanding claims.
• Review and appeal denied or underpaid claims.
• Communicate with insurance companies to resolve claim issues.

Skills

Analytical skills

Communication skills

Critical thinking

Multitasking

Friendly phone demeanor

Education

High school diploma or equivalent

Associate or bachelor's degree preferred

Tools

Microsoft Office suite

Salesforce

Waystar

Job description

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MedScope, a division of Medical Guardian, is a rising leader in the medical alarm industry, seeking a seasoned Revenue Cycle Specialist with health insurance claims experience to fill a role in the Revenue Cycle Department. The Revenue Cycle Specialist is responsible for managing an assigned book of business consisting of Medicaid payers to ensure accurate and timely reimbursement for healthcare services. This role focuses on claim follow-up, denial resolution, payer correspondence, and ensuring compliance with payer-specific guidelines. The specialist serves as the primary point of contact for assigned payer accounts and works to resolve outstanding balances through proactive follow-up and problem-solving. Ability to analyze data and think critically is a must.

This is a full-time, remote position requiring a daily schedule of 9:00am-5:00pm EST.

Permanent residency in one of the following states is required: PA, DE, GA, MI, NC, TX, NJ, and FL only.

Hourly rate: $22/hour

Key Duties and Responsibilities

• Manage a defined book of insurance payers and serve as the subject matter expert for each.


• Meet or exceed monthly productivity and resolution objectives, and KPIs centered around collection percentage goals.


• Conduct timely follow-up on outstanding claims, ensuring resolution and reimbursement within established payer timelines.


• Review, analyze, and appeal denied or underpaid claims in accordance with payer policies and contractual obligations.


• Identify trends in denials and underpayments and elevate issues to management.


• Communicate with insurance companies via phone, payer portals, or written correspondence to resolve claim issues.


• Ensure all claim activity is accurately documented within the billing system for audit and tracking purposes.


• Monitor payer-specific timely filing limits and authorization processes to ensure compliance.


• Prepare and submit corrected claims or claim reconsiderations as needed.


• Stay updated on payer guidelines, filing terms, authorization workflows, and general rules.


• Limited phone work exclusively dealing with care managers; minimal to no direct interaction with patients or consumers.

Requirements

• Must be legally authorized to work in the United States without the need for employer sponsorship now or in the future.


• Proficiency in the Microsoft Office suite of applications required.


• Strong analytical skills.


• Strong communication with excellent oral and written communication skills.


• Critical thinking - ability to decipher when things are missing or incorrect.


• Accurate and organized with the ability to multitask.


• Friendly phone demeanor - will be in direct contact with care managers.


• Self-starter who can work in a remote environment. Must be able to work both independently and collaboratively on a small team and be accustomed to working with deadlines.


• Punctual and reliable with a professional appearance and demeanor.

Desired Experience

• High school diploma or equivalent required; associate or bachelor's degree preferred.


• 2+ years of experience in medical billing or revenue cycle management, with emphasis on insurance follow-up or A/R.


• Experience with Medicaid and Managed Care Organization a plus.


• Strong understanding of claim lifecycles, payer policies, and denial management.


• Familiarity Salesforce and/or Waystar is a plus.


• Ability to work independently and manage time effectively within a high-volume environment.

Benefits

• Health Care Plan (Medical, Dental & Vision)


• Paid Time Off (Vacation & Public Holidays)


• Short Term & Long Term Disability


• Retirement Plan (401k)