Revenue Cycle Specialist, Bilingual – Spanish
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Job Description
Revenue cycle specialist managing healthcare claims, payments, denials, and receivables for CareSpot Urgent Care. Supporting accurate billing and customer service across corporate revenue-cycle operations.
Responsibilities:
- Prepare healthcare claims for submission, including pre-bill claim edits/review and manual updates to insurance and billing data
- Submit claims to assigned insurance, workers’ compensation, and occupational medical payers/employers in accordance with department procedures and applicable regulations
- Provide coverage and assistance to various teams based on volume and priorities
- Process payer and patient credit card payments, including card-on-file payments, using InstaMed and NextGen
- Provide documentation to payers to resolve workers’ compensation claim issues or denials when assigned
- Research and follow up on outstanding accounts receivable for assigned payers
- Coordinate with payers, operational managers, and revenue cycle team members to resolve receivables, rebill claims, and submit appeals
- Update insurance, charge, and claims data for accurate billing and rebilling
- Review, process, and follow up on payer and revenue-cycle correspondence daily
- Distribute correspondence received through fax, mail, lockboxes, and payer portals to appropriate RCM team members
- Resolve returned patient statements
- Analyze and resolve internal and external customer concerns received through billing inquiries and other communication channels
- Provide phone coverage for the Corporate Customer Service Representative when needed
- Provide customer service and communication to internal and external customers and team members
- Complete accounts receivable requests accurately and timely
- Complete updates from daily NextGen reports, including the Employer Not on File report
- Perform other duties as assigned
Requirements:
- 2+ years of relevant healthcare billing, claims submission, payment posting, denials management and/or accounts receivable follow-up experience
- Experience with outpatient clinic, physician, hospital experience, or a combination of areas
- Deep understanding of CMS 1500 medical billing rules and supporting documentation requirements for Medicare, Medicaid, workers’ compensation, or similar payers
- Knowledge of ICD-10 diagnosis codes, CPT/HCPCS, modifiers, and medical terminology
- Attention to detail and proven analytical skills; ability to identify trends in denials and claims issues
- Proficient with Microsoft Office, specifically Excel, Outlook, Word, Teams, OneNote, and SharePoint or similar tools
- Experience with healthcare practice management or billing systems
- High School diploma required
- Associate degree or above preferred
- Bilingual in Spanish preferred
- Ability to lift and/or move up to 40 pounds
Benefits:
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Employee may work in office or remotely dependent upon company and/or department policies
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