Revenue Cycle Billing Specialist

Revenue Cycle Billing Specialist

Department: Revenue Cycle Management (RCM) Reports To: Revenue Cycle Manager Employment Classification: Full-Time | Non-Exempt Location: Johnson City, TN (on-site)

Position Summary

The Revenue Cycle Billing Specialist is responsible for the accurate, timely, and compliant preparation, submission, and management of medical claims to insurance payers. This position plays a critical role in optimizing revenue cycle performance by ensuring services are appropriately documented, charges are accurately captured, claims are submitted promptly, and billing errors are proactively identified and resolved.

The ideal candidate demonstrates strong attention to detail, knowledge of medical billing practices, and a results-oriented approach to maximizing clean claim submissions while minimizing avoidable denials and reimbursement delays.

Essential Duties and Responsibilities

Claims Processing and Submission

· Review patient encounters to ensure charges are accurately captured and submitted.

· Verify patient demographics, insurance coverage, eligibility, and billing information.

· Review CPT, HCPCS, ICD-10-CM codes, modifiers, and applicable payer billing requirements for accuracy, escalating clinical coding questions as appropriate.

· Prepare and submit electronic and paper claims in accordance with established timelines.

· Monitor clearinghouse submissions, claim acknowledgments, and rejections.

· Correct and resubmit rejected claims promptly.

· Ensure timely filing requirements are consistently met.

Billing Accuracy and Quality Assurance

· Identify missing charges, incomplete documentation, coding discrepancies, and billing errors.

· Coordinate with providers, clinical personnel, and administrative teams to resolve documentation or charge entry issues.

· Monitor unbilled encounters and claims pending submission.

· Maintain awareness of Medicare, Medicaid, and commercial payer billing guidelines.

· Assist in identifying recurring billing issues and opportunities for process improvement.

Revenue Cycle Coordination

· Collaborate with collections specialists to resolve claim defects and prevent recurring denials.

· Support the development of standardized billing workflows and quality control processes.

· Maintain accurate documentation of billing activities and claim corrections.

· Escalate systemic billing issues or payer-related concerns to RCM leadership.

Required Qualifications

· High school diploma or equivalent required; associate degree preferred.

· Minimum 2 years of medical billing or physician-practice revenue cycle experience preferred.

· Working knowledge of CPT, ICD-10-CM, HCPCS, insurance billing requirements, and medical terminology.

· Experience with electronic health record and practice management systems; Athenahealth experience preferred.

· Familiarity with Medicare, Medicaid, and commercial insurance billing.

· Proficiency with Microsoft Excel and standard office applications.

· Strong organizational, analytical, and problem-solving skills.

Preferred Qualifications

· Certified Professional Biller (CPB) or Certified Professional Coder (CPC).

· Experience in a multispecialty or multi-location physician practice.

· Familiarity with clearinghouse workflows, payer portals, and claim-editing tools.

Performance Expectations

The Billing Specialist is expected to maintain consistent daily productivity, manage assigned billing queues, proactively resolve submission barriers, and ensure that claims are processed accurately and efficiently.

Success in this position is measured by the quality, timeliness, and completeness of billing activities and the reduction of preventable revenue cycle delays.

Benefits:

Medical, Dental, Vision, PTO, 401k, and Weekends off!