Revenue Cycle Specialist

Job Details: Level: Experienced, Job Location: Kalesta Healthcare Group

• Rocklin, CA, Position Type: Full Time, Education Level: High School, Salary Range: $25.00 - $45.00Hourly, Travel Percentage: None, Job Shift: Any, Job Category: Health Care, Centralized Revenue Cycle Billing Specialist Position Summary The Centralized Revenue Cycle Billing Specialist is responsible for accurate, timely, and compliant billing across assigned Skilled Nursing Facilities (SNFs). This position supports centralized revenue cycle operations by ensuring claims are generated, validated, submitted, corrected, and followed through to payment. The Specialist partners closely with facility Revenue Cycle Managers (RCMs), the RCM Support Team, and the Director of Revenue Cycle Management to strengthen billing consistency, reduce delays, and support sustainable A/R performance.

Pay Range

$25.00–$45.00 per hour, depending on experience and qualifications.

Key Responsibilities

Centralized Billing Manage centralized billing for assigned SNF facilities and payer portfolios. Generate and submit Medicare, Medicaid/Medi-Cal, Managed Care, commercial, and other third-party claims. Validate claims for accuracy and completeness prior to submission. Review claim edits, rejections, and billing errors and resolve them timely.

Ensure claims are submitted within payer and regulatory timely filing requirements. Maintain established billing schedules and month-end deadlines. Verify appropriate payer sequencing and billing information. Submit corrected claims, adjustments, and voids as necessary. Track outstanding claims through final resolution.

Revenue Cycle & A/R Support Review outstanding accounts receivable to identify unbilled claims, rejected claims, payment delays, and other billing barriers. Work claim-related denials and coordinate necessary corrections or supporting documentation. Assist with reducing DSO and aged A/R through timely and accurate billing.

Escalate systemic payer, authorization, credentialing, or billing issues that may negatively impact cash flow. Support reconciliation of billed services to expected reimbursement. Identify trends affecting reimbursement and communicate findings to Revenue Cycle leadership. Month-End & Triple Check Support the month-end billing process and established close calendar.

Ensure claims are generated and billing errors are addressed ahead of Triple Check. Participate in Triple Check and other billing validation processes as assigned. Confirm required billing documentation is available prior to claim submission. Assist facilities with resolving billing deficiencies identified during Triple Check.

Ensure approved claims are transmitted timely following completion of required validation. Collaboration & Facility Support Partner with facility RCMs to resolve census, payer, authorization, eligibility, and documentation issues affecting billing. Communicate outstanding billing barriers and required actions clearly and timely.

Work collaboratively with Revenue Cycle leadership, Operations, clinical teams, MDS, Medical Records, Therapy, and other departments as needed. Provide education and billing guidance to facility revenue cycle teams. Promote accountability and consistent centralized billing practices across assigned facilities. Compliance & Quality Maintain compliance with CMS, state Medicaid programs, payer requirements, and company policies.

Protect resident and organizational information in accordance with HIPAA and confidentiality requirements. Maintain accurate billing records and supporting documentation. Participate in billing audits and corrective action initiatives. Remain current on payer billing requirements and regulatory changes affecting SNF reimbursement.

Performance Expectations Success in this position is measured by: Timely submission of clean claims Reduction of unbilled accounts Timely resolution of claim rejections and billing-related denials Compliance with billing and month-end deadlines Accuracy of claims submitted Reduction in billing-related A/R aging Improvement in DSO and cash collections Effective communication and escalation of billing barriers Consistent adherence to company policies and regulatory requirements Reporting Structure Reports To: Director of Revenue Cycle Management or designated Revenue Cycle leadership Department: Revenue Cycle Management / Centralized Billing Role Objective The primary objective of the Centralized Revenue Cycle Billing Specialist is to create a consistent, accurate, and sustainable centralized billing process that protects revenue, accelerates reimbursement, and allows facility RCM teams to maintain greater focus on collections, resident financial management, and overall A/R performance.

Qualifications

Qualifications

Minimum 2–3 years of healthcare billing or revenue cycle experience preferred. Skilled Nursing Facility billing experience strongly preferred. Working knowledge of Medicare Part A and B, Medicaid/Medi-Cal, Managed Care, and commercial insurance billing. Understanding of SNF reimbursement, UB-04 claims, payer requirements, eligibility, authorizations, denials, and A/R follow-up.

Experience with Point. Click. Care (PCC) or similar healthcare billing/EHR systems preferred. Strong analytical, organizational, and problem-solving skills. Ability to manage multiple facilities, payer types, and billing deadlines simultaneously. Strong written and verbal communication skills. Ability to work independently while maintaining strong collaboration with facility and Support Center teams.