• Contract type: Independent Contractor
  
• Night Shift Schedule: Monday to Thursday - 8:45am to 5pm New York Time (8:45pm - 5am Manila Time)
  
• Friday - 8:45am to 3:45pm New York Time (8:45pm - 3:45am Manila Time)
  
  
  

Role Summary

The Revenue Cycle Specialist is responsible for managing the full revenue cycle process, from provider enrollment and prior authorizations through claims submission, reimbursement, and follow-up. This role ensures timely, accurate billing and payment while identifying and resolving issues that impact cash flow.

 

Responsibilities:

Provider Enrollment

• Manage provider enrollments and re-credentialing with commercial and government payers

• Track enrollment status and follow up with payers as needed

• Maintain accurate provider and payer records

Prior Authorizations

• Obtain prior authorizations based on payer requirements

• Verify eligibility and benefits prior to services

• Communicate authorization approvals, denials, and requirements to internal teams

Claims Submission & Billing

• Review claims for accuracy and completeness prior to submission

• Submit electronic and paper claims using billing software

• Audit documentation to ensure services billed are supported

• Address and correct rejected claims in a timely manner

AR / Reimbursement / Follow-Up

• Post payments, ERAs, and EOBs accurately

• Follow up on unpaid, underpaid, and no-response claims

• Investigate and resolve denials, including resubmissions and appeals

• Track outstanding balances and identify trends impacting reimbursement

Reporting & Collaboration

• Identify recurring issues and recommend process improvements

• Provide regular updates on AR status, denials, and enrollment issues

• Attend team meetings and complete assigned follow-ups

• Strong attention to detail and organizational skills. 
  
• Ability to plan, prioritize, and meet deadlines in a fast-paced environment.
  
• Advanced reading comprehension and ability to synthesize complex data into actionable processes.
  
• Willingness to learn, grow, and adapt to evolving processes.  
  
• Genuine commitment to client success, beyond task completion. Focuses on driving results that add optimum value, not just checking boxes.
  
• Excellent communication skills—both written and verbal—with clarity and conciseness.
  
• Collaborative team player
  
• Demonstrates initiative and accountability to achieve high-quality results.
  
• Demonstrates persistence and professionalism in working with payors to achieve effective outcomes.
  

Requirements

Job ID: 45910388130