Revenue Cycle Specialist: Physician Billing & Appeals

Coding Ahead LLC; California; On-site; USD 60,000 - 75,000; Full time

Job summary

Torrance Memorial is seeking an experienced Patient Account Representative to manage revenue cycle processes including data entry, charge processing, and claims follow-up. You will address patient and insurance inquiries, monitor denials, and process refunds while ensuring compliance with coding standards.

Responsibilities include reviewing EOBs, preparing write-off requests, and supporting training of new staff.

Qualifications

• Minimum of 3 years of experience in physician billing.
• Knowledge of ICD-10, CPT, HCPCS, and LCD/NCD coding.
• Ability to ensure compliance with accepted coding and billing guidelines.
• Strong understanding of insurance billing functions.
• Experience handling claims, denials, appeals, refunds, and accounts receivable follow-up.

Responsibilities

• Review work queues and prioritize tasks to ensure timely follow-up on patient accounts.
• Confirm pre-bill edits are cleared and required signatures are obtained before billing.
• Gather documentation needed to respond to initial data requests and appeals.
• Answer inquiries from patients and insurance companies regarding charges and billing discrepancies.
• Track denied claims and appeals, including payments and adjustments.
• Review explanation of benefits and remittance advices to resolve accounts and pursue appropriate follow-up.
• Support charity allowance documentation and collection referrals when needed.
• Assist with orientation and training of new employees or volunteers.
• Attend meetings and seminars with insurance plans, medical groups, and IPAs.
• Document detailed notes, action items, and correspondence activity.
• Resolve payer issues and patient billing complaints, escalating issues to management as appropriate.
• Issue denial letters within required timeframes.
• Perform collection actions with patients, insurance companies, and third-party payers.
• Prepare write-off requests for denied claims that cannot be appealed.
• Review claim scrubber results and correct claim edits.
• Access computer systems to retrieve patient information.
• Review patient accounts with credit balances and submit refund requests when appropriate.

Skills

Physician billing experience

Attention to detail

Customer service

Tools

ICD-10 coding

CPT coding

HCPCS coding

LCD/NCD coding

Job description

Torrance Memorial is seeking an experienced Patient Account Representative to manage revenue cycle processes including data entry, charge processing, and claims follow-up. You will address patient and insurance inquiries, monitor denials, and process refunds while ensuring compliance with coding standards.

Responsibilities include reviewing EOBs, preparing write-off requests, and supporting training of new staff.