Bilingual Specialist, Revenue Cycle Management

Accountabilities:

Manage end-to-end revenue cycle activities, including insurance verification, charge entry, claims processing, payment monitoring, and accounts receivable follow-up.
Verify patient eligibility, insurance benefits, plan types, dual-eligible status (D-SNP), and primary care provider assignments through payer portals and eligibility tools.
Resolve insurance discrepancies with payers and internal teams, accurately documenting and updating coverage information in Collectly.
Enter and code medical charges using ICD-10, CPT, and HCPCS codes, ensuring accuracy and compliance with applicable billing requirements.
Prepare, submit, review, and process electronic and paper insurance claims while ensuring adherence to payer-specific guidelines.
Monitor rejected and denied claims in Elation and practice management systems, investigate issues, correct errors, and coordinate timely resubmissions.
Manage accounts receivable by following up on outstanding claims, contacting insurance providers, tracking payments, and resolving reimbursement discrepancies.
Generate patient statements, respond to billing and insurance inquiries, and establish payment arrangements when necessary.
Maintain accurate billing documentation and ensure compliance with applicable federal and state regulations, as well as payer requirements.
Prepare and analyze monthly billing reports and key performance indicators (KPIs), identify trends, and recommend improvements to revenue cycle processes.
Collaborate with healthcare providers, insurance companies, and internal departments to resolve billing challenges and improve operational efficiency.
Requirements:
High school diploma or GED required; a Medical Billing and Coding certification is preferred.
At least 3 years of experience managing end-to-end healthcare billing and revenue cycle processes.
Previous experience in value-based care environments is highly desirable.
Strong understanding of insurance verification, medical billing, claims submission, denial management, and accounts receivable processes.
Familiarity with ICD-10, CPT, and HCPCS coding standards and healthcare reimbursement requirements.
Experience using payer portals, eligibility verification tools, and practice management or electronic medical record systems; familiarity with Elation and Collectly is beneficial.
Intermediate Microsoft Excel skills and the ability to analyze billing data, prepare reports, and monitor performance metrics.
Excellent attention to detail, organizational skills, and the ability to manage multiple priorities while maintaining accuracy.
Strong analytical, problem-solving, and communication skills, with the ability to collaborate effectively across different teams.
Bilingual proficiency in English and Spanish is highly preferred, particularly for communicating with patients and other stakeholders.
Benefits:
Competitive compensation.
Comprehensive medical and dental insurance coverage.
Free mental health support and life coaching for employees and their dependents.
Generous paid time off (PTO).
Paid holidays.
Paid community service day.
Paid parental and family leave.
Paid bereavement leave.
401(k) retirement plan with company matching.
Purpose-driven work environment focused on improving healthcare access and patient experiences.
Inclusive and collaborative workplace culture that values diversity, professional growth, and continuous improvement.