The Revenue Cycle Specialist is responsible for supporting the revenue cycle process through timely and accurate accounts receivable follow-up, denial resolution, and payer communication. This role focuses on execution of daily revenue cycle activities to ensure clean claims, appropriate reimbursement, and compliance with payer requirements.

The Revenue Cycle Specialist works collaboratively with the Revenue Cycle Supervisor, front office teams, billing partners, and payers to resolve reimbursement issues, escalate complex cases as appropriate, and support revenue cycle performance goals.

Essential Function

• Review, analyze, and follow up on assigned accounts receivable to ensure timely reimbursement.
• Investigate, resolve, and work denied, rejected, or underpaid claims in accordance with payer guidelines and internal workflows.
• Submit appeals and supporting documentation accurately and within payer-required timeframes.
• Work payer and internal work queues to correct billing, registration, and claim errors.
• Communicate directly with commercial, government, and managed care payers regarding claim status, payment discrepancies, and resolution.
• Document all follow-up activity, payer communication, and outcomes accurately in billing systems.
• Ensure insurance, demographic, and billing information is accurate and updated to support compliant claim submission.
• Respond to patient billing inquiries related to insurance processing, balances, and explanation of benefits as needed.
• Identify trends, recurring issues, or barriers impacting reimbursement and escalate to the Revenue Cycle Supervisor.
• Collaborate with front office and operational partners to resolve issues impacting claims and reimbursement.
• Support audit activities by providing documentation, account detail, and follow-up clarification as requested.
• Participate in training, meetings, and process improvement initiatives as assigned.
• Maintain compliance with all applicable laws, regulations, payer requirements, and company policies.

Required Skills & Abilities

• Proficiency in Microsoft Word, Excel, Window-based applications.
• Excellent communication and relationship-building skills.
• Must have demonstrated skill in prioritizing daily responsibilities and crises to handle a heavy workload.
• Must be able to work successfully in a fast-paced environment.
• Knowledge of federal and state employment laws and regulations

Required Credentials

• Working knowledge of healthcare revenue cycle processes including billing, accounts receivable, denials, and appeals.
• Strong attention to detail and ability to follow established workflows and payer guidelines.
• Effective verbal and written communication skills, including professional payer interactions.
• Strong organizational skills with the ability to manage assigned workloads and deadlines.
• Ability to problem-solve within defined escalation pathways.
• Proficiency in Microsoft Word, Excel, and Windows-based applications.
• Ability to work collaboratively in a team-based environment.
• Strong customer service skills and professionalism when handling sensitive financial conversations

Compensation:

• $18-20 hourly + Incentive plan (Any posted pay range considers a wide range of compensation factors, including candidate background, experience, and work location, while also allowing for salary growth within the position)

Expanding Access to Quality Care 

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training. 

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact.  

Let’s go further together and transform care. Join the #PTSLife today!  

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