The Revenue Specialist plays a crucial role in the Revenue Operations team, reporting directly to the Revenue Operations Supervisor. This involves actively reviewing and validating claim information, promptly correcting billing errors to maintain data precision, analyzing denied claims to identify reasons for denial, and implementing workflow and procedural enhancements to minimize denials. The role also includes collaborating with the billing team to address claim submission discrepancies, contributing to denial management efforts, actively participating in revenue optimization initiatives, and fostering close teamwork for a cohesive and cooperative approach to achieving optimal financial performance.

The role encompasses information management, including record management, subpoena response, and credentialing responsibilities. This involves both new and re-credentialing processes.

Essential Duties:

• Denial Management: Analyze denied claims to identify reasons for denial. Promptly correct billing errors to maintain data precision.
• Payer Outreach: Contacting payers to gather information on claim denials.
• Process Improvement: Assist with implementing revenue-related processes and strategies to enhance operational efficiency.
• Collaboration: Collaborating with partner leadership, corporate leadership, the billing team, IT, and payers to resolve issues.
• Credentialing: Collaborate with relevant partner-level staff to collect, submit, and/or verify required credentials. Initiate credentialing and re-credentialing processes for applicable clinical staff and maintain working status.
• Information Management: Facilitate the release of medical records to authorized personnel, including clients, healthcare facilities, and insurance companies. Respond to subpoenas and court orders, ensuring accurate coordination and legal compliance. Uphold the highest standards of privacy, security, and legal requirements, particularly within the scope of HIPAA.
• Facility: Support facility licensing and enrollment process.
• Contracts: Support the contract management process.
• Teamwork: Foster close teamwork for a cohesive and cooperative approach to achieving optimal financial performance.
• Reporting: Contribute to regular reporting on key performance indicators (KPIs) related to revenue processes.
• Meetings: Attend and actively contribute to staff meetings within the Revenue Operations team.
• Training: Attend relevant training to stay updated on industry best practices, regulatory changes, and emerging trends.

Employment benefits include:

• Competitive Salaries that commensurate with experience
• Health, Dental, Vision Benefits
• FSA / HSA
• Company Paid Basic Life
• Voluntary Supplemental Benefits such as Accident, Critical Illness, Short Term Disability, etc.
• 401K Plan

ncgCARE and its affiliated partners are committed to equal opportunity for all, without regard to race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. ncgCARE will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. If you are interested in applying for an employment opportunity and feel you need a reasonable accommodation pursuant to the ADA, please contact us at hrteam@ncgcare.com. If you require relay service assistance, please click on the following link to review information on your state’s relay service: http://transition.fcc.gov/cgb/dro/trsphonebk.html

ncgCARE participates in the E-Verify program. Therefore, any employment with ncgCARE will also be contingent upon confirmation from the Social Security Administration (“SSA”) and/or the Department of Homeland Security (“DHS”) of your authorization to work in the United States.

ncgCARE offers excellent compensation packages including salary commensurate with experience and benefits to meet your needs for today and the future.

ncgCARE and all partner affiliates maintain a drug-free workplace.

Experience

• 1 - 3 years: Basic knowledge of denial management processes is required; Experience in a similar role within healthcare revenue operations, billing, or claims processing is preferred.

Education

• Bachelors or better