Revenue Cycle Specialist - Medical Billing

Job Title: Medical Billing - Revenue Cycle Management Specialist
Department: Revenue Cycle Management
Reports To: Billing Manager
Location: South Jordan, Utah
Position Type: Full-Time

Job Summary
We are seeking a highly skilled and detail-oriented Medical Billing - Revenue Cycle Management Specialist to join our South Jordan, Utah team. In this role, you will manage the end-to-end billing process for Out-of-Network (OON) providers, ensuring claims are processed accurately and efficiently. This is a key position for a professional who thrives in a fast-paced environment and is passionate about optimizing revenue cycle operations.

Roles & Responsibilities
Claim Management:

• Oversee the full lifecycle of claims, from submission to final payment, for professional and facility services.
• Communicate with insurance companies to resolve denials, underpayments, and other discrepancies.
• Use payer portals (e.g., Availity ) to verify eligibility and claims status.
• Submit medical records, file appeals, and process reconsiderations to maximize reimbursements.

Billing and Compliance:

• Ensure claims comply with current coding standards (CPT, ICD-10) and regulatory requirements.
• Post payments, reconcile accounts, write off balances, and prepare patient statements as necessary.
• Leverage tools such as Optum EncoderPro to review and verify billing accuracy.
• Handle negotiations with third-party vendors (e.g., Multiplan, MARS, Zelis) for OON claims and Single Case Agreements.

Communication and Collaboration:

• Provide exceptional customer service to patients with billing inquiries, including setting up payment plans.
• Collaborate with payers to resolve issues and track escalated account trends.
• Communicate billing and system updates effectively to management and team members.

Data Management and Reporting:

• Maintain detailed records of claim statuses, payments, and adjustments.
• Prepare performance reports to identify trends and areas for improvement.
• Support audit requests by ensuring all documentation is accurate and up to date.

Qualifications
Education and Experience:

• High school diploma or equivalent (required); Associate's or Bachelor's degree in a related field (preferred).
• Minimum of 3 years of experience in medical billing, collections, or revenue cycle management.
• Lightning Steps Experience preferred

Technical Skills:

• Proficiency in medical billing software and EHR systems (e.g., Imagine, ADS).
• Knowledge of HICFA, UB04, Tax ID, NPI, and insurance guidelines for OON claims.
• Familiarity with payer processes, including Gap exceptions, prior authorizations, and federal IDR arbitration.

Soft Skills:

• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.

Preferred Qualifications:

• Experience with Microsoft Office applications (Word, Excel, Teams, Power BI) and Zendesk.
• Prior experience handling OON provider registration with major payers.

Compensation and Benefits

• Pay Range: $50,000 - $65,000 annually (commensurate with experience).
• 401(k) with employer matching
• Health, dental, and vision insurance
• Life insurance and employee assistance program
• Generous paid time off and holidays

Key Performance Indicators (KPIs)

• Claims submitted within 48 hours of receipt.
• Denial resolution rate of 95% within 30 days.
• Accounts receivable aging below 45 days.
• Patient inquiry resolution within 24 hours.

Work Schedule

• Full-time, 40 hours per week.
• 8-hour shift, Monday to Friday, with flexibility as needed.

Our Investment in You

• Competitive salary with performance-based bonuses.
• Comprehensive benefits package, including medical, dental, and vision coverage.
• 401(k) with company match.
• Paid time off, including vacation, sick days, and holidays.
• Ongoing training and professional development opportunities.

Disclaimer
OCD Anxiety Centers is committed to providing equal opportunity for all employees and
applicants, regardless of race, color, religion, sex, national origin, age, marital status,
sexual orientation, genetics, disability, political affiliation, or any other legally protected
class under federal, state, or local law.

Salary : $50,000 - $65,000