Revenue Cycle Specialist

Description

The Revenue Cycle Specialist is responsible for the accurate and timely submission of claims across the programs and services provided by Easterseals Bluegrass, and for the resolution of denied and unpaid claims for the Prescribed Pediatric Extended Care (PPEC) program. This role consolidates claim submission activity currently distributed across program and administrative staff, establishing a single point of accountability within the Finance department for claim accuracy and reimbursement follow-through.

Reporting to the Chief Financial Officer, the Revenue Cycle Specialist reviews service documentation, verifies eligibility, authorization status, coding, and modifier requirements prior to submission, and works claims through adjudication to payment. This position supports financial sustainability by increasing first-pass claim accuracy, reducing preventable denials, and shortening the time between service delivery and reimbursement.

Essential Job Duties and Responbilities: 

• Prepare and submit claims for pediatric therapy, applied behavior analysis, Prescribed Pediatric Extended Care, and adult      day health services across multiple billing systems
• Review service documentation, coding, modifier application, eligibility, and authorization status prior to claim submission
• Identify and correct clearinghouse rejections and front-end claim edits
• Maintain program-specific submission schedules to ensure consistent and timely filing
• Support the transition of adult day health billing from a monthly to a weekly submission cycle
• Research, correct, and resubmit denied and rejected claims for the Prescribed Pediatric Extended Care program
• Categorize denials by reason code and identify root cause, whether billing, coding, authorization, eligibility, or documentation
• Prepare and file formal appeals within payer-specific filing and appeal timeframes
• Track appeals to resolution and escalate non-responsive payers to the Chief Financial Officer
• Monitor timely filing deadlines and prioritize claim work by dollars at risk and days remaining
• Submit and track prior authorization requests,  renewals, and supporting documentation for the Prescribed Pediatric      Extended Care program
• Cross-train on pediatric therapy authorization workflows to provide backup coverage during absences
• Provide backup coverage for claim submission for other programs as needed
• Monitor Kentucky Medicaid and managed care policy changes — fee schedules, code sets, and modifier requirements — and      communicate updates to the Chief Financial Officer
• Serve as a point of contact with payer representatives for routine claim and reimbursement matters
• Ensure billing practices comply with payer policies, healthcare billing regulations, and organizational procedures
• Prepare daily deposits and associated supporting documentation
• Compile a monthly denial report by program and reason code for the Chief Financial Officer
• Support internal and external audits by providing requested claim documentation and payer correspondence
• Maintain accurate billing records, supporting documentation, and audit trails in accordance with HIPAA

Requirements

• High school diploma or equivalent; Associate’s degree in Accounting, Healthcare Administration, or a related field preferred
• Minimum of 2 years of experience in medical, healthcare, or human services billing, including claim submission and denials
• Working knowledge of Medicaid or managed care claim adjudication, remittance advices, and appeal processes
• Demonstrated ability to learn and work across more than one billing or practice management system
• Experience with billing or accounting software and Excel
• Strong attention to detail and the ability to work a  claim queue independently
• Commitment to the mission of Easterseals and to  ethical financial practices

Benefits:

• Medical, Dental, and Vision Insurance
• Paid Holidays
• Paid Time Off
• 401K Retirement Plan
• Employee Assistance Program

Easterseals is an Equal Opportunity Employer. We are committed to creating a diverse environment and are proud to be an inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Easterseals is dedicated to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, please contact us at [email protected].