Revenue Cycle Specialist

POSITION SUMMARY:

The Revenue Cycle Specialist is responsible for the end-to-end management of professional billing functions, including charge review, claim submission, payer follow-up, payment posting, and patient account resolution. This role requires strong working knowledge of modern revenue cycle technology, payer portals, and regulatory requirements to ensure accurate, timely reimbursement and a positive patient financial experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES (included but not limited to):

• Review and validate provider charges in the practice management system for accuracy, completeness, and compliance prior to claim submission.
• Perform claim scrubbing and ensure clean claim submission through systems such as athenaOne or equivalent platforms.
• Submit and monitor claims through clearinghouses and payer portals including Availity Essentials, NaviNet, and payer-specific websites.
• Conduct insurance follow-up on outstanding claims using A/R aging reports, payer portals, and direct payer outreach.
• Identify, research, and resolve claim denials; initiate and track appeals as needed.
• Post payments (insurance and patient) accurately by line item, including reconciliation of EOBs/ERAs.
• Utilize electronic remittance advice (ERA) and 835 files to ensure efficient payment posting and denial identification.
• Review zero-pay and underpaid claims to ensure reimbursement aligns with contracted rates.
• Follow up on patient balances, including outbound calls and portal communication, while maintaining a high level of customer service.
• Process refunds in accordance with payer policies and compliance guidelines.
• Verify patient demographics and insurance eligibility at the time of billing to prevent downstream denials.
• Maintain familiarity with payer policies, reimbursement rules, and billing guidelines, including Medicare and Medicaid requirements.
• Communicate billing trends, payer issues, and workflow gaps to management for process improvement.
• Support front desk and clinical teams with billing-related education and feedback to improve clean claim rates.

REQUIRED SKILLS & QUALIFICATIONS:

• 2–5+ years of experience in medical billing, accounts receivable, or revenue cycle operations.
• Strong understanding of CPT, ICD-10, and payer reimbursement methodologies.
• Practice Management/EHR systems (e.g., athenaOne or similar).
• Payer portals (e.g., Availity Essentials, NaviNet, UHC/Optum, BCBS portals).
• Clearinghouses and ERA/835 processing tools.
• Microsoft Excel and reporting tools for A/R and payment analysis.
• Experience working with commercial payers, Medicare, and Medicaid.
• Hands-on experience with payer portals and electronic claim management tools.
• Familiarity with denial management, appeals, and contract reimbursement validation.
• High attention to detail with strong analytical and problem-solving skills.
• Ability to manage workload independently in a hybrid work environment.
• Adhere to all HIPAA, OSHA, and compliance regulations.
• High ethical standards and ability to maintain confidentiality.
• Follow all internal policies and payer billing guidelines.

PREFERRED:

• Experience in multi-specialty or primary care environments.
• Exposure to AI-assisted coding or automation tools (e.g., claim scrubbing or auto-coding platforms).
• Knowledge of value-based care models and payer-specific nuances.

WORK ENVIRONMENT/PHYSICAL DEMANDS:

• Hybrid, in-office ~4 days per week/remote setting, with extended periods of sitting and computer work.
• Collaborative, fast-paced revenue cycle team supporting multiple providers and specialties.

TOTAL REWARDS AT VANOVA HEALTH SOLUTIONS:

At Vanova, we see Total Rewards as more than just a paycheck and recognize that value comes in many forms. It is the full experience of being a part of our incredible team working toward a shared, mission-driven purpose.  We’re proud to offer competitive compensation, health and wellness benefits, a retirement savings plan, time off to recharge, learning opportunities to continually grow, and meaningful work in a collaborative culture that fosters team connection through shared celebrations and appreciation events.

We are committed to investing in the future of our people and focused on expanding our total rewards to support every stage of your journey with us.

• The anticipated hourly rate for this role is $26.00-$27.00.
• This position offers an opportunity for annual target bonus based on individual performance and company financial performance.
• Comprehensive benefits based on eligibility include a 401K retirement savings plan with company match, paid time off, and health benefits (medical, prescription drug, dental and vision insurance).
• Please note that individual total compensation for this position will be determined at the Company’s sole discretion and may vary based on several factors, including but not limited to location, skill level, years and depth of relevant experience, and education.

EEOC Statement: Vanova Health is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

This job description is intended to describe the general nature and level of work performed and is not an exhaustive list of all responsibilities, duties, and skills associated with it. Duties and expectations may be subject to change with or without notice.

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