Technical Specialist

Jobtailor; Kentucky; On-site; USD 40,000 - 60,000; Full time

Job summary

Jobtailor is seeking a Revenue Cycle Specialist in Kentucky to manage non-clinical denials, appeals and payment variances. You will coordinate with payors, patients, and internal teams to maximize collections while ensuring HIPAA compliance and data quality.

The role focuses on research, documentation, and submission of payer appeals, with heavy interaction across departments and participation in joint operating calls. Strong attention to policy and deadlines is essential.

Qualifications

• Associate degree or equivalent; 3 years of related experience.
• 3 years’ experience with customer service and stakeholder interaction.
• Proficient in Microsoft Office and payer research tools.
• Knowledge of Medicare/Medicaid regulations and insurance guidelines.
• HIPAA compliance knowledge.
• Ability to prioritize workload to meet deadlines.

Responsibilities

• Review non-clinical denials and research resolutions.
• Perform follow-up, appeals and referrals to stakeholders.
• Address accounts in work queues and complete required activities.
• Prepare and submit payer appeals; Escalate via joint operating calls.
• Communicate with payors to resolve payments accurately.
• Monitor aged accounts and report payment variances.
• Collaborate with internal staff and management on process improvements.

Skills

Non-Clinical Denials

Appeals Processing

Payment Variance Resolution

Data Quality Management

Aged Account Reporting

HIPAA Compliance

Policy Adherence

Stakeholder Communication

Education

Associate degree

High school diploma + CRCR Certification

Tools

Microsoft Office

Payer Spreadsheets

Research Systems

Job description

• Review, research and address non-clinical denials
• Address accounts assigned to work queues and complete required activities
• Perform follow-up, appeals and referrals to stakeholders
• Investigate and respond to information requests to resolve outstanding accounts
• Monitor denial accounts and document actions to maximize collection dollars
• Use appropriate systems to research accounts and submit processing or appeal information
• Follow up with patients to obtain additional information
• Prepare and submit payer appeals, including escalation through payer joint operating calls
• Make outgoing calls and answer incoming calls
• Revise insurance information and request rebilling or account adjustments as appropriate
• Review, work and accurately report aged accounts
• Track and report payer prompt-pay/adjudication violations and follow up with payers
• Interface with internal and external staff to resolve payment variance issues
• Report issues and trends to management and collaborate on solutions
• Facilitate joint operating calls, manage payer spreadsheets, coordinate meetings and submit agendas
• Participate in educational activities and maintain compliance with policies, regulations and privacy requirements
• Meet expectations for data quality, customer service, payment variance turnaround and productivity
• Perform other duties as assigned

Requirements

• Associate degree OR high school diploma plus Certified Revenue Cycle Representative and 3 years of related experience
• 3 years’ experience including customer service etiquette and interaction with internal and external stakeholders
• Proficiency in Microsoft Office applications and others as required
• Knowledge and understanding of organizational policies and procedures
• Knowledge of insurance regulations, payment guidelines and policies
• Ability to communicate and work with payors to get accounts resolved and paid accurately
• Extensive knowledge of Medicare and Medicaid regulations
• Knowledge of third-party claim filing, contract reimbursement and other insurance guidelines
• Compliance with federal, state and local regulations and HIPPA
• Satisfactory attendance and punctuality
• Ability to prioritize work/resources to accomplish objectives and meet deadlines

Core Competencies

Demonstrates expertise in managing non-clinical denials, appeals, and payment variance issues while ensuring compliance with insurance regulations and organizational policies. Proficient in utilizing Microsoft Office applications and maintaining high standards of customer service and data quality.

Highest-signal resume keywords

• Certified Revenue Cycle Representative
• Medicare and Medicaid Regulations
• Insurance Regulations
• Customer Service Etiquette
• Third-Party Claim Filing

Hard Skills

• Non-Clinical Denial Management
• Appeals Processing
• Payment Variance Resolution
• Data Quality Management
• Account Adjustments
• Payer Joint Operating Calls
• Insurance Information Revision
• Aged Account Reporting
• Compliance with HIPAA
• Organizational Policies and Procedures

Soft Skills

• Communication with Stakeholders
• Collaboration with Internal Staff
• Prioritization of Work
• Customer Service
• Problem-Solving

Certifications & Qualifications

• Certified Revenue Cycle Representative

Industry Keywords

• Payment Guidelines
• Contract Reimbursement
• Federal Regulations
• State Regulations
• Local Regulations

Tools & Technologies

• Microsoft Office Applications
• Payer Spreadsheets
• Research Systems