Revenue Cycle Billing Specialist (Remote, Remote, US)

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).

- Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct.

- Maintain awareness of and actively participate in the Corporate Compliance Program.

- Maintain a confidential and orderly remote work area.

- Meet specified goals and objectives assigned by management and/or the Client.

- Assist with other projects as assigned by management.

Expected / Key Results

- Deliver high levels of client and patient satisfaction (CSAT)

- Achieve quality scores per defined process standards

- Deliver defined process-specific metrics (e.g., AR days, cash collected, productivity units)

- Adherence to regulatory compliance requirements

- Schedule adherence

Preferred Educational Qualifications

- High school diploma or equivalent required

- Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred

Preferred Work Experience

- 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up

- Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up

- Prior experience with Epic billing and/or follow-up work queues strongly preferred

- Familiarity with Medicaid, Medicare, and commercial payers preferred

- Experience reading and interpreting 835 ERA / EOB remittance data

Competencies & Skills

- Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes

- Proficiency with Epic (HB and/or PB modules, work queues, claim correction, and rebilling)

- Familiarity with CARC/RARC denial and adjustment reason codes

- Ability