Senior Revenue Cycle Specialist Work From Home

Role Summary

We are seeking a seasoned highly organized Senior Revenue Cycle Specialist to join our SWAT / Level 3 (L-3) support team the most senior tier of our revenue cycle operation. This team owns the resolution of complex escalated billing issues across the entire client base including accounts served by both our internal billing teams and our outsourcing (BPO) partners. The right person is a true problem-solver: someone who can take a tangled high-stakes claims or setup issue perform a disciplined root cause analysis drive it to resolution across multiple teams and document a repeatable fix so it does not happen again.

This is a hands-on fast-paced role for a professional who thrives under pressure communicates clearly with everyone from front-line billers to executive leadership and takes personal ownership of outcomes. You will act as a subject matter expert (SME) a cross-team connector and a force multiplier for the quality of our revenue cycle.

Key Responsibilities

Escalation Management & Root Cause Analysis

• Serve as a senior point of resolution for escalated complex and high-dollar billing issues routed from internal billing teams BPO partners support/help desk retention and client-facing staff.

• Perform detailed root cause analysis on denials rejections underpayments payment-posting anomalies and configuration errors identifying the true upstream driver (eligibility enrollment credentialing coding setup or payer behavior) rather than applying surface-level fixes.

• Identify and capture all affected claims and accounts when a systemic issue is found and drive corrective action end-to-end through to verified resolution.

• Document findings clearly and present recommendations and corrective-action plans to team leads and leadership.
  
  

Cross-Functional Coordination & Communication

• Partner daily with multiple teams internal billing BPO partners Enrollment Credentialing Portals QA Data Entry Onboarding and Retention to resolve issues that span team boundaries.

• Own and manage hand-offs between functions (for example credentialing-completion to enrollment-initiation to system updates) ensuring tasks are routed tracked and closed correctly.

• Communicate status blockers and resolutions proactively and professionally so that no issue becomes invisible work.
  
  

Account Setup Configuration & Workflow Execution

• Execute and verify account setup and configuration changes including new-client billing setup in-house (IH) and full-service (FS) conversions service-facility and demographic updates and payer/plan additions.

• Initiate and confirm EDI/ERA enrollment and related setup steps coordinating with the Enrollment team and following established checklists and SOPs.

• Validate that changes produce the intended downstream result (clean claim submission correct adjudication accurate posting).
  
  

Subject Matter Expertise SOPs & Process Improvement

• Act as a subject matter expert and escalation resource for the broader RCM organization fielding questions and providing authoritative guidance.

• Author refine and maintain Standard Operating Procedures (SOPs) and training materials based on issues resolved helping standardize how the team works.

• Continuously look for ways to eliminate manual steps reduce repeat issues and improve efficiency including through automation and AI-assisted workflows where appropriate.
  
  

Client & Executive-Level Communication

• Communicate efficiently and professionally with clients (practices and their staff) on escalated matters representing the organization with a polished credible client-ready presence.

• Prepare and deliver clear written and verbal updates to executive leadership translating detailed billing findings into concise decision-ready summaries.
  
  

Performance Productivity & Quality

• Manage a high volume of concurrent tasks against productivity and completion-rate targets without sacrificing accuracy.

• Support and help move key revenue cycle metrics in the right direction for example net collection rate (NCR) aged AR (AR > 120 days) denial rate and first-pass resolution through faster cleaner issue resolution.

• Maintain meticulous documentation and notes so that every action is traceable and auditable.
  
  

Required Qualifications

• 5 years billing experience. Minimum five (5) years in a fast-paced high-volume medical billing / revenue cycle role.

• Proven multitasking ability. Demonstrated success managing many concurrent priorities and escalations at once under time pressure without dropping details.

• Detailed root cause analysis. A track record of diagnosing the underlying cause of billing problems and resolving them at the source not just clearing the symptom.

• Strong cross-team collaboration. Ability to work well with and communicate effectively across multiple teams and stakeholders.

• Multiple billing systems. Working knowledge of more than one billing / practice-management / RCM system with the ability to learn new platforms quickly.

• Professional client-ready communication. A professional appearance and presence with the ability to communicate with clients efficiently clearly and with credibility.

• Fluent English. Fluency in spoken and written English.

• Excellent organizational skills. Highly organized detail-oriented and disciplined about documentation and follow-through.

• Executive communication experience. Experience communicating and interacting directly with executive leadership.

• Subject matter expert. Able to serve as an SME and trusted escalation resource for others.

• Fast learner. Picks up new systems payer rules and processes quickly and independently.

• Flexible availability. Willing and able to work extra hours when needed to resolve time-sensitive issues.

• Goal-driven. Self-motivated accountable and focused on measurable outcomes.
  
  

Preferred Qualifications

• Hands-on denials and appeals experience across commercial Medicare and Medicaid payers including direct payer outreach and navigating payer portals.

• Familiarity with X12 EDI transactions (837P/837I 835 ERA 270/271) clearinghouses and payer enrollment / credentialing workflows (e.g. CAQH PECOS Availity state Medicaid portals).

• Experience in chiropractic behavioral / mental health physical therapy podiatry or other specialty billing.

• Experience working escalations across an outsourced (BPO) delivery model.

• Proficiency with Excel / Google Sheets for analysis (pivots lookups).

• Relevant certification (e.g. CRCR CPB CPC) and/or a degree in a business finance or healthcare-related field.
  
  

Systems & Technical Knowledge

Comfort working across the modern RCM technology stack including billing / practice-management platforms clearinghouses and payer portals EDI / ERA tooling and standard productivity and ticketing tools. Specific platform training is provided; the ability to learn new systems quickly is essential.

Work Schedule & Conditions

• Must have stable internet connection minimum of 30 MBPS

• Must be comfortable working the US business hours

• Must own a laptop with at least 16 GB memory