Revenue Cycle Specialist
- Edgewater Health
- Gary, Indiana
- 2 days ago
- Hybrid Full Time
Job Summary
Employment Type
Full Time
Job Description
Job DetailsJob Location: Corporate Headquarters - Gary, IN 46402Position Type: Full TimeEducation Level: 4 Year DegreeTravel Percentage: NoneJob Shift: DayJob Category: FinancePosition Summary
The Revenue Cycle Specialist is responsible for managing and optimizing the organization’s revenue cycle processes to ensure accurate billing, timely reimbursement, and compliance with healthcare regulations. This role supports financial performance by overseeing claim submission, payment posting, denial management, and account resolution while delivering excellent service to patients, payers, and internal stakeholders. This is a on-site position, not a remote position.
Key Responsibilities
Billing & Claims Management
Prepare, review, and submit accurate claims to insurance payers and government programs.
Ensure coding, documentation, and charge capture align with payer and regulatory requirements.
Monitor claim edits, rejections, and clearinghouse reports; resolve issues promptly.
Track claim status and follow up to ensure timely adjudication.
Denial Management & Collections
Investigate and resolve denied or underpaid claims.
Identify denial trends and recommend corrective actions.
Prepare and submit appeals with appropriate supporting documentation.
Work aging reports to reduce accounts receivable (A/R) days.
Payment Posting & Reconciliation
Post payments accurately from electronic remittances (ERA/EOB).
Reconcile daily deposits and ensure alignment with general ledger processes.
Identify payment discrepancies and escalate when necessary.
Patient Account Resolution
Respond to patient billing inquiries with professionalism and clarity.
Establish payment plans and assist patients in understanding financial responsibility.
Maintain confidentiality and compliance with HIPAA guidelines.
Compliance & Regulatory Adherence
Ensure all billing activities comply with federal, state, and payer-specific regulations.
Maintain knowledge of CMS guidelines, payer policies, and reimbursement methodologies.
Support internal and external audits by providing required documentation.
Reporting & Process Improvement
Analyze A/R, denial rates, and reimbursement patterns.
Assist in preparing monthly revenue cycle performance reports.
Recommend workflow improvements to increase efficiency and reduce revenue leakage.
Participate in system optimization and training initiatives.
QualificationsRequired Qualifications
High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, Finance, or related field preferred.
2–4 years of experience in medical billing, revenue cycle, or healthcare finance.
Knowledge of CPT, ICD-10, and HCPCS coding principles (working knowledge required; certification a plus).
Experience with electronic health records (EHR) and practice management systems.
Strong understanding of insurance verification claims lifecycle, and reimbursement processes.
Proficiency in Microsoft Office, particularly Excel.
Preferred Certifications (if applicable)
Certified Revenue Cycle Specialist (CRCS)
Certified Professional Biller (CPB)
Certified Healthcare Financial Professional (CHFP)
Core Competencies
Attention to detail and accuracy
Analytical and problem-solving skills
Strong organizational and time-management abilities
Excellent communication and customer service skills
Ability to work independently while meeting productivity goals
Commitment to compliance, confidentiality, and ethical standards
Key Performance Indicators (KPIs)
Days in Accounts Receivable (A/R)
Clean Claim Rate
Denial Rate and Appeal Success Rate
Net Collection Percentage
Timely Filing Compliance
Patient Account Resolution Timeliness
Work Environment
This position operates in a professional office or healthcare environment and may require prolonged computer use. Remote or hybrid work may be available depending on organizational needs.
Physical Requirements
Prolonged sitting and computer use
Ability to review detailed financial and medical documentation
Occasional lifting of files or materials (up to 15 lbs.)
The Revenue Cycle Specialist is responsible for managing and optimizing the organization’s revenue cycle processes to ensure accurate billing, timely reimbursement, and compliance with healthcare regulations. This role supports financial performance by overseeing claim submission, payment posting, denial management, and account resolution while delivering excellent service to patients, payers, and internal stakeholders. This is a on-site position, not a remote position.
Key Responsibilities
Billing & Claims Management
Prepare, review, and submit accurate claims to insurance payers and government programs.
Ensure coding, documentation, and charge capture align with payer and regulatory requirements.
Monitor claim edits, rejections, and clearinghouse reports; resolve issues promptly.
Track claim status and follow up to ensure timely adjudication.
Denial Management & Collections
Investigate and resolve denied or underpaid claims.
Identify denial trends and recommend corrective actions.
Prepare and submit appeals with appropriate supporting documentation.
Work aging reports to reduce accounts receivable (A/R) days.
Payment Posting & Reconciliation
Post payments accurately from electronic remittances (ERA/EOB).
Reconcile daily deposits and ensure alignment with general ledger processes.
Identify payment discrepancies and escalate when necessary.
Patient Account Resolution
Respond to patient billing inquiries with professionalism and clarity.
Establish payment plans and assist patients in understanding financial responsibility.
Maintain confidentiality and compliance with HIPAA guidelines.
Compliance & Regulatory Adherence
Ensure all billing activities comply with federal, state, and payer-specific regulations.
Maintain knowledge of CMS guidelines, payer policies, and reimbursement methodologies.
Support internal and external audits by providing required documentation.
Reporting & Process Improvement
Analyze A/R, denial rates, and reimbursement patterns.
Assist in preparing monthly revenue cycle performance reports.
Recommend workflow improvements to increase efficiency and reduce revenue leakage.
Participate in system optimization and training initiatives.
QualificationsRequired Qualifications
High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, Finance, or related field preferred.
2–4 years of experience in medical billing, revenue cycle, or healthcare finance.
Knowledge of CPT, ICD-10, and HCPCS coding principles (working knowledge required; certification a plus).
Experience with electronic health records (EHR) and practice management systems.
Strong understanding of insurance verification claims lifecycle, and reimbursement processes.
Proficiency in Microsoft Office, particularly Excel.
Preferred Certifications (if applicable)
Certified Revenue Cycle Specialist (CRCS)
Certified Professional Biller (CPB)
Certified Healthcare Financial Professional (CHFP)
Core Competencies
Attention to detail and accuracy
Analytical and problem-solving skills
Strong organizational and time-management abilities
Excellent communication and customer service skills
Ability to work independently while meeting productivity goals
Commitment to compliance, confidentiality, and ethical standards
Key Performance Indicators (KPIs)
Days in Accounts Receivable (A/R)
Clean Claim Rate
Denial Rate and Appeal Success Rate
Net Collection Percentage
Timely Filing Compliance
Patient Account Resolution Timeliness
Work Environment
This position operates in a professional office or healthcare environment and may require prolonged computer use. Remote or hybrid work may be available depending on organizational needs.
Physical Requirements
Prolonged sitting and computer use
Ability to review detailed financial and medical documentation
Occasional lifting of files or materials (up to 15 lbs.)
Job Summary
Employment Type
Full Time
Benefit Insights
Health Insurance
Vacation Leave
Sick Leave
Holiday Pay
Life Insurance
Dental Insurance
Vision Insurance
Short-Term Disability
Edgewater Health
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Job ID: 511427333
Originally Posted on: 2/26/2026
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