Revenue Cycle Specialist - TGH Access Operations

Florida Health Sciences Center Tampa General Hospital; Tampa (FL); Ibrido; USD 52.000 - 75.000; Tempo pieno

Descrizione del lavoro

Tampa General Hospital (TGH) Access Operations is seeking a Revenue Cycle Specialist to manage day-to-day revenue cycle functions, ensuring accurate billing, timely reimbursement, and regulatory compliance. The role covers front-end and back-end tasks including insurance verification, charge capture, billing, and denial follow-up within oncology services.

The successful candidate will monitor payer guidelines, update tracking tools, and collaborate with billing teams to optimize reimbursement

Competenze

• Associate degree or equivalent in a related field and 2-3 years in a medical billing setting.
• Experience with insurance verification, billing, and denial resolution in a healthcare environment.
• Knowledge of CPT, HCPCS, ICD-10 coding and payer guidelines applicable to oncology.
• Familiar with CMS, Medicare, Medicaid and commercial payer requirements.

Mansioni

• Oversee front-end and back-end processes: insurance verification, benefit analysis, charge capture, billing, payment posting, and denial resolution.
• Ensure compliance with state and federal regulations and payer guidelines.
• Confirm patient coverage, analyze benefits, and obtain authorizations for accurate billing.
• Explain financial responsibilities to patients and assist with financial assistance programs.

Conoscenze

Insurance verification

Billing & denials

Medical coding CPT/HCPCS/ICD-10

Regulatory compliance

Patient financial counseling

Financial analysis

Workflow optimization

Formazione

Associate’s Degree Business

Associate’s Degree Finance

Associate’s Degree Accounting

Associate’s Degree Related Field

Strumenti

Billing software

EMR/EHR systems

Descrizione del lavoro

Job Description - Revenue Cycle Specialist - TGH Access Operations (260004IU)

Job Description

Revenue Cycle Specialist - TGH Access Operations - ( 260004IU )

Description

Supports oncology practices by managing day-to-day revenue cycle functions to ensure accurate billing, timely reimbursement, and regulatory compliance. Performs front-end and back-end revenue cycle activities including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial follow-up. Evaluates patient financial and insurance coverage, educates patients on financial responsibilities, and assists in securing financial assistance and external resources to support access to care. Maintains accurate billing logs, reimbursement references, and payer-specific guidelines in accordance with state and federal regulations. Reviews documentation requests, resolves charge rejections and denials, and coordinates with billing offices and claims teams to ensure timely claim submission and resubmission. Develops and maintains patient tracking and financial reporting tools to support reimbursement accuracy and operational visibility. Acts as a knowledgeable resource for revenue cycle processes, oncology reimbursement requirements, and compliance standards, contributing to process improvements that enhance efficiency while minimizing financial and legal risk.
Essential Functions

• Oversee front-end and back-end processes including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial resolution.
• Maintain adherence to state and federal healthcare regulations (CMS, Medicare, Medicaid) and payer-specific guidelines to minimize financial and legal risk.
• Confirm patient coverage, analyze benefits, and secure authorizations to ensure accurate billing and timely reimbursement.
• Communicate cost estimates, explain co-pays, deductibles, and assist patients in accessing financial assistance programs.
• Validate referrals, diagnosis codes, and procedure codes; resolve charge rejections and coordinate with billing teams for timely claim submission.
• Investigate and correct claim denials and rejections, ensuring resubmission within payer timelines.
• Develop and update patient tracking systems, billing logs, and financial reporting tools to support operational visibility.
• Serve as a resource for oncology reimbursement requirements, compliance standards, and best practices in revenue cycle management.
• Identify opportunities to enhance workflow efficiency, reduce errors, and optimize reimbursement outcomes.
• Other duties as assigned.

Qualifications

Education Qualifications

• Associate’s Degree Business
• Associate’s Degree Finance
• Associate’s Degree Accounting
• Associate’s Degree Related Field

Experience Qualifications

• A minimum of 2-3 years of experience working within a medical billing department.
• An equivalent combination of education/certification and realized competencies can substitute for the required education

Skills and Abilities

• Ability to manage front-end and back-end processes including insurance verification, charge capture, billing, payment posting, and denial resolution.
• Skilled in confirming coverage, analyzing benefits, and ensuring financial clearance.
• Strong knowledge of medical coding systems: CPT, HCPCS, and ICD-10, and their application in oncology services.
• Payer-Specific Authorization and Medical Necessity Requirements
• In-depth knowledge of state and federal healthcare regulations (CMS, Medicare, Medicaid, and commercial insurance compliance standards).
• Knowledge of authorization processes, medical necessity criteria, and reimbursement guidelines.
• Ability to analyze, resolve, and prevent claim denials and rejections.
• Skilled in explaining financial responsibilities and assisting with financial assistance programs.
• Competence in reviewing referrals, diagnosis, and procedure codes for accurate billing.
• Ability to develop and maintain patient tracking systems and financial reporting tools.

Primary Location

Tampa

Work Locations

TGH Main Campus 1 Tampa General Circle Tampa 33601

Eligible for Remote Work : Hybrid Remote

Schedule

Full-time

Scheduled Days : Monday, Tuesday, Wednesday, Thursday, Friday