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Revenue Cycle Billing Specialist (Remote, Remote, US)

United States · remote · Salary not listed

Role overview

Role Description

The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives reimbursement from government and commercial payers. The ideal candidate has strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.

Roles & Responsibilities

Claim Follow-Up – PB & HB

Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone calls, payer websites, and Epic work queues to ensure timely reimbursement.
Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments.
Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
Identify payer trends and payment discrepancies across both PB and HB claim types and escalate findings to leadership.
Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable.
Escalate claims with payers for resolution on inaccurate or delayed claim processing.

Appeals & Reconsiderations

Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification.
Adhere to payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.

Payer & System Knowledge

Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data.
Utilize payer portals (Availity, NaviMedix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs.
Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.

Compliance & Documentation

Ensure accurate and detailed documentation of all follow-up activities in Epic.
Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections.
Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies.
Always maintain confidentiality of patient and account information (HIPAA).

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Revenue Cycle Billing Specialist (Remote, Remote, US)

Role overview

Role Description

Roles & Responsibilities

Claim Follow-Up – PB & HB

Appeals & Reconsiderations

Payer & System Knowledge

Compliance & Documentation

Expected / Key Results

Preferred Educational Qualifications

Preferred Work Experience

Competencies & Skills

Not Accepting Referrals