Revenue Cycle Specialist

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $20 - $25 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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EMS Management & Consultants, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

EMS Management & Consultants, Inc. (EMS|MC) is a company that specializes in providing comprehensive operational solutions for over 1,500 emergency medical services (EMS) providers across the United States, including hospital systems, municipalities, and private companies. Founded by professionals within the EMS industry, EMS|MC offers services designed to optimize reimbursement, resources, and regulatory compliance. With more than 25 years of experience, the company leverages technologies like EMsmart, a SaaS-driven billing solution, to enhance revenue performance for EMS agencies. EMS|MC also works closely with the PWW Advisory Group to ensure compliance with the ever-changing regulatory landscape, providing tools and educational resources to EMS providers.

📋 Description

• Review, resolve, and process Air client claims throughout the revenue cycle in a timely, accurate, and compliant manner • Monitor assigned client accounts and claim inventories for revenue risks, reimbursement delays, aging trends, and performance improvement opportunities • Prioritize and resolve pending, rejected, denied, underpaid, stalled, and aged claims, including accounts over 120 days • Manage claims across commercial insurance, TRICARE, workers’ compensation, VA, Medicare, Medicaid, and other government-funded programs • Contact payers and use approved portals to verify claim status, eligibility, benefits, payment details, filing requirements, and required follow-up actions • Obtain medical records and supporting documentation, engaging patients or authorized parties when appropriate • Prepare and submit claim corrections, reconsiderations, and appeals, including verbal appeals when appropriate • Research underpayments, overpayments, payment discrepancies, and remaining balances; prepare refund documentation when required • Identify account issues and root causes, resolve issues within authority, and escalate complex or unresolved matters • Monitor client outcomes against productivity, quality, turnaround-time, operating procedure, and service-level standards • Communicate payer trends, recurring deficiencies, workflow barriers, client concerns, and improvement opportunities to operational and management teams • Collaborate with onshore and offshore team members and cross-functional revenue cycle partners • Maintain current knowledge of payer policies, prompt-payment requirements, regulatory changes, and Air client-specific procedures • Deliver professional service and maintain constructive relationships with payers, clients, patients, leaders, and colleagues • Perform other duties as assigned

🎯 Requirements

• High school diploma or equivalent • One to two (1-2) years of experience in medical billing, insurance follow-up, denials management, healthcare accounts receivable, or claim resolution; one (1) year of EMS billing experience may substitute for the broader experience requirement • Working knowledge of healthcare revenue cycle processes, insurance benefits, payer types, claim status follow-up, denials, underpayments, correspondence, and appeals • Ability to learn, interpret, and apply payer requirements, client procedures, compliance standards, prompt-payment guidelines, and filing and appeal deadlines • Working knowledge of HIPAA requirements and ability to protect confidential patient and client information • Strong analytical, critical-thinking, and problem-solving skills • Strong attention to detail and ability to document account activity clearly, accurately, and completely • Strong organizational and time-management skills, with ability to prioritize multiple work queues and deadlines • Effective written and verbal communication and customer-service skills • Ability to work independently and collaboratively with cross-functional, onshore, and offshore teams • Ability to adapt to changing payer requirements, client needs, systems, procedures, priorities, and responsibilities • Proficiency with Microsoft Office applications • Ability to navigate billing systems, document-management tools, payer portals, and multiple applications efficiently • Proficiency in English is necessary for job-related communication • Preferred: experience supporting air medical, emergency medical services, ambulance billing, or another complex healthcare revenue cycle environment • Preferred: experience with commercial insurance, TRICARE, workers' compensation, VA, Medicare, Medicaid, or other government payer claim follow-up • Preferred: experience with medical insurance collections, denials, appeals, medical terminology, and aged accounts • Preferred: proficiency in EMS|MC billing software or a comparable ambulance billing platform • Must be authorized to work in the United States now and in the future; no current or future visa sponsorship

🏖️ Benefits

• Discretionary bonus plan • Retirement plan • Health coverage • Paid time off • Comprehensive benefit package • Necessary equipment provided, including computer, monitor, keyboard, mouse, and headset • Reasonable accommodations for qualified individuals with disabilities • Quiet, private workspace requirement for approved hybrid or remote employees • Reliable internet connection required for hybrid/remote work