Revenue Cycle Claims Specialist

The Revenue Cycle Claims Specialist is responsible for managing the medical billing and claims process for facility and/or professional services. This role ensures accurate, timely, and compliant submission of claims to insurance payors, resolves billing discrepancies, and supports the organization’s revenue cycle operations. SPECIFIC SKILLS NEEDED

• Proficiency with at least one major hospital EHR/billing system (e.g. Epic, Cerner/Oracle, Meditech, or similar), with demonstrated ability to learn new systems quickly
• Experience working within a clearinghouse and payor portals
• Strong knowledge of facility (UB04) and professional (1500) claim requirements, revenue codes, DRGs, and hospital reimbursement methodologies
• Working knowledge of Medicare/Medicaid billing rules and commercial payor requirements
• Demonstrated ability to independently research and resolve claim rejections and meet clean claim/productivity objectives
• Proficient in Microsoft Excel for reconciliation and reporting. EDUCATION/EXPERIENCE/TRAINING Required:
• High school diploma required
• 2-5 years of hospital (institutional) billing experience. Preferred:
• Associate degree in health information management, medical billing, or related field preferred
• Understanding of Medi-Cal billing requirements and regulations
• Experience with Independent Physician Association (“IPA”) and Health Plan relationships
• Certification or credentialed proficiency in Epic EHR preferred
• Certified Revenue Cycle Representative (CRCR) or Certified Professional Biller (CPB)
• Experience working across multiple EHR/billing systems or supporting a system conversion/migration.