Revenue Cycle Management Specialist responsible for end-to-end billing operations, ensuring timely insurance reimbursement and patient payments for a virtual pediatric care company.
Locations (4)
Philippines
Bogotá, Colombia
Medellín, Colombia
Mexico City, Mexico City, Mexico
Compensation
Competitive Salary: Based on experience and skills
Responsibilities
Verify insurance eligibility and benefits
Validate demographics, insurance details, CPT and ICD-10 codes, modifiers, and place of service before submission
Submit claims within payer timely filing requirements
Monitor clearinghouse and payer acknowledgments, correct and resubmit rejected claims
Route coding questions to the designated reviewer
Requirements
Nice to have: CPB or CRCR certification
Nice to have: Medicaid managed care plans
Nice to have: practice management or EHR system
Nice to have: pediatric or behavioral health or telehealth billing
This position is responsible for reviewing and posting charges, resolving failed claims and rejections, posting payments and adjustments, timely processing of secondary insurance, processing denials, bimonthly rebills, following up with insurance companies on accounts not paid, customer service, and collections of private past due accounts.
Responsible for managing outpatient billing and collections, ensuring accurate claim submission, resolving denials, and maintaining customer service standards.
Compensation
The pay range for this position is $24.00 - $26.00/hr.
Responsibilities
Respond to government payers by phone or correspondence concerning claims issues
Assist with all calls, correspondence and concerns regarding Medicare claims with the FIs
Take action on bill review requests from the Collections Team in a timely manner
Complete worklist daily and ensure all accounts are set for follow up
Review unbilled accounts and ATB to ensure timely billing and collection
Perform comprehensive audits of acute care outpatient facility coding to ensure accuracy, regulatory compliance, and appropriate reimbursement.
Compensation
$36.00/hour during production
Responsibilities
Conduct comprehensive audits of acute care outpatient medical records using iCodeOne to validate accurate ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
Review outpatient facility services, procedures, and clinical documentation to ensure coding accuracy and completeness.
Evaluate coding practices for compliance with CMS, OIG, AHIMA, AAPC, payer-specific, and client requirements.
Review outpatient reimbursement accuracy, including OPPS, APC assignments, and applicable Medicare guidelines.
Identify coding errors, documentation gaps, compliance risks, and reimbursement opportunities.
Requirements
Bachelor's degree in Health Information Management, Healthcare Administration, or a related field (or equivalent experience)
Nice to have: Bachelor's degree in Health Information Management, Healthcare Administration, or a related field
Nice to have: Experience using iCodeOne or similar coding audit platforms
Nice to have: Experience auditing multiple outpatient service areas such as emergency department, observation, same-day surgery, or ancillary services
Works part of a centralized Revenue Cycle team to process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including /edit reviews.
Responsibilities
Ensure timely and accurate processing of claims in a manner that is consistent with company processes and procedures and industry best practices through direct efforts and coordination of other efforts.
Determines correct sequence of ICD 10, CPT and HCPCS codes
Answer coding questions from providers and staff assisting in definition and guidance of all applicable regulatory standards and correct coding initiatives.
Analyzes and evaluates provider coding to ensure standards are adhered to and provides guidance to providers as needed.
Maintains strictest confidentiality to all HIPAA guidelines/regulations.
Responsible for the administration, interpretation, implementation, and auditing of all IHCS and CMS payor contracts, provider agreements, reimbursement schedules, and fee structures.
Compensation
Offering a competitive compensation package, including but not limited to; Medical, Vision, Dental, Short- and Long-term insurance 6+ Days of Holidays Pay 17 days of PTO Employer paid life insurance 401K with employer contribution Wellness program with reward incentives Employee recognition and reward programs Comprehensive paid training program
Responsibilities
Ensure contractual terms, reimbursement rates, billing requirements, and amendments are accurately documented and reflected in applicable billing systems
Perform ongoing contract and reimbursement audits to identify discrepancies, prevent revenue leakage, ensure compliance, and maximize reimbursement accuracy
Responsible for establishing, maintaining, testing, and monitoring accurate billing configurations within Credible EHR to ensure accurate and timely Louisiana Medicaid behavioral health claim generation and revenue cycle integrity.
Responsibilities
Ensure billing configuration accuracy within Credible
Translate payer requirements into documented billing workflows and system configurations
Build, test, validate, and implement billing changes with audit documentation
Audit billing rules, fee schedules, authorizations, and service definitions
Monitor claims, denials, rejections, and underpayments to identify issues
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