Job Summary
The Revenue Cycle Specialist - Air is responsible for reviewing, resolving, and processing Air client claims throughout the revenue cycle in a timely, accurate, and compliant manner. This role performs proactive payer follow-up, resolves pending, denied, underpaid, and aged claims, and addresses account barriers to maximize reimbursement and minimize revenue loss. The Revenue Cycle Specialist – Air collaborates with internal and external partners, identifies payer and account trends, and supports continuous improvement while meeting operational performance standards and client service commitments.
Major Responsibilities/Activities
- Monitor assigned Air client accounts and claim inventories to identify revenue risks, reimbursement delays, aging trends, and opportunities to improve performance.
- Prioritize and resolve pending, rejected, denied, underpaid, stalled, and aged claims—including accounts over 120 days—in accordance with payer requirements, client specifications, compliance standards, service-level agreements, and leadership direction.
- Manage claims across assigned payer categories, including commercial insurance, TRICARE, workers’ compensation, VA, Medicare, Medicaid, and other government-funded programs.
- Contact payers and use approved portals to verify claim status, eligibility, benefits, payment details, filing requirements, and additional actions or information needed for resolution.
- Obtain medical records and other supporting documentation, engaging patients or authorized parties when appropriate to advance pending or denied claims.
- Prepare and submit claim corrections, reconsiderations, and appeals, including verbal appeals when appropriate, and document all actions accurately and completely.
- Research underpayments, overpayments, payment discrepancies, and remaining balances; determine the appropriate resolution and prepare refund documentation for leadership approval when required.
- Identify account issues and root causes, take appropriate action within established authority, follow matters through completion, and escalate complex or unresolved issues with clear supporting information.
- Monitor client outcomes against established commitments, productivity and quality standards, operating procedures, and service-level agreements; communicate payer trends, recurring deficiencies, workflow barriers, client concerns, and improvement opportunities to operational and management teams.
- Collaborate with onshore and offshore team members and cross-functional revenue cycle partners to support accurate account handling, effective prioritization, and timely reimbursement.
- Maintain current knowledge of payer policies, prompt-payment requirements, regulatory changes, and Air client-specific procedures while delivering professional service and maintaining constructive relationships with payers, clients, patients, leaders, and colleagues.
- Perform other duties as assigned.
