Revenue Cycle Specialist
Remote in the USFull-TimeMiddle
Salary70,000 - 90,000 USD per year
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Job Details
- Experience
- 2–5 years
- Required Skills
- Google Workspace
Requirements
- 2–5 years of revenue cycle, billing, or claims experience in a laboratory, diagnostic, or genetic testing environment.
- Hands-on experience with Xifin preferred.
- Experience with other lab RCM systems or clearinghouses (Change Healthcare/Optum, Availity, payor portals).
- Demonstrated experience working claims for out-of-network providers with commercial payors.
- Working knowledge of both front-end and back-end rejections and denials, and a proven track record of successful appeals.
- Required working knowledge of the following denial categories: Prior authorization, Medical necessity, Timely filing, Eligibility, Coordination of benefits, Non-covered services.
- Sharp attention to detail and the patience to work high volumes of detailed administrative tasks without losing accuracy.
- High-energy, go-getter mentality.
- Strong written and verbal communication skills, including the ability to write clear, persuasive appeal letters.
- Comfort with ambiguity and a willingness to roll up your sleeves in a small, fast-moving team.
- Proficient in Google Workspace, Excel, and modern RCM/billing tooling.
Responsibilities
- Own day-to-day claim and denials management across MyOme's book of business, working claims through resolution in our RCM system and payor portals.
- Investigate and resolve both front-end and back-end rejections and denials, identifying root causes and partnering with internal teams to prevent recurrence.
- Draft, submit, and track appeals across commercial and government payors, including out-of-network claim scenarios, with strong documentation and follow-through.
- Work denials across the full category spectrum — prior authorization, medical necessity, timely filing, eligibility, coordination of benefits, and non-covered services — escalating systemic issues with proposed solutions.
- Navigate clearinghouses (e.g., Change Healthcare/Optum, Availity) and payor portals to verify eligibility, check claim status, and pull EOBs and remittance detail.
- Execute the manual, time-consuming administrative billing tasks that keep the operation moving — demographic and insurance corrections, claim resubmissions, payor follow-up calls, and documentation upload.
- Maintain meticulous notes and worklog hygiene in the RCM system so that every claim has a clear audit trail.
- Surface trends in denial reasons, payor behavior, and process gaps to the Head of RCM and contribute ideas for workflow improvements.
- Collaborate with Customer Support, Clinical Operations, and Lab teams to resolve the upstream issues that drive downstream denials.
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