Revenue Cycle Specialist

Summary

Join MedScope, a division of Medical Guardian, as a Revenue Cycle Specialist! This full-time, remote position focuses on managing Medicaid payer accounts to ensure timely reimbursement. You will handle claim follow-up, denial resolution, and payer correspondence, requiring strong analytical and communication skills. The ideal candidate possesses 2+ years of medical billing or revenue cycle management experience, with a focus on insurance follow-up. Permanent residency in PA, DE, GA, MI, NC, TX, NJ, or FL is required. The hourly rate is $22/hour. This role offers benefits including health insurance, paid time off, short-term and long-term disability, and a 401k retirement plan.

Requirements

• Proficiency in the Microsoft Office suite of applications required
• Strong analytical skills
• Strong communication with excellent oral and written communication skills
• Critical thinking - ability to decipher when things are missing or incorrect
• Accurate and organized with the ability to multitask
• Friendly phone demeanor - will be in direct contact with care managers
• Self-starter who can work in a remote environment. Must be able to work both independently and collaboratively on a small team and be accustomed to working with deadlines
• Punctual and reliable with a professional appearance and demeanor

Responsibilities

• Manage a defined book of insurance payers and serve as the subject matter expert for each
• Meet or exceed monthly productivity and resolution objectives, and KPIs centered around collection percentage goals
• Conduct timely follow-up on outstanding claims, ensuring resolution and reimbursement within established payer timelines
• Review, analyze, and appeal denied or underpaid claims in accordance with payer policies and contractual obligations
• Identify trends in denials and underpayments and escalate issues to management
• Communicate with insurance companies via phone, payer portals, or written correspondence to resolve claim issues
• Ensure all claim activity is accurately documented within the billing system for audit and tracking purposes
• Monitor payer-specific timely filing limits and authorization processes to ensure compliance
• Prepare and submit corrected claims or claim reconsiderations as needed
• Stay updated on payer guidelines, filing terms, authorization workflows, and general rules
• Limited phone work exclusively dealing with care managers; minimal to no direct interaction with patients or consumers

Preferred Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred
• 2+ years of experience in medical billing or revenue cycle management, with emphasis on insurance follow-up or A/R
• Experience with Medicaid and Managed Care Organization a plus
• Strong understanding of claim lifecycles, payer policies, and denial management
• Familiarity Salesforce and/or Waystar is a plus
• Ability to work independently and manage time effectively within a high-volume environment

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Paid Time Off (Vacation & Public Holidays)
• Short Term & Long Term Disability
• Retirement Plan (401k)