Revenue Specialist, OSM
Core
Ensure proper submission and adjudication of Medicaid claims while managing patient health information (PHI) and adhering to HIPAA guidelines.
Role type
Medicaid revenue cycle specialist (billing & claims processing)
Builds
Clean AR management, reduced denials, and accurate reimbursement for hospital claims
Domain
Healthcare revenue cycle management (Medicaid, UB-04 billing)
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medicaid claims processing, UB-04 billing, HIPAA compliance, medical record research, payer follow-up, claim denial appeals, data analysis
Preferred skills
CMS-1500 billing, complex claims experience, Medicaid payer knowledge
Technologies
EnableComp E360 RCM, MS Office (Word, Excel, Outlook), copy/scan/print machines
Responsibilities
Verify patient eligibility, analyze Medicaid claim payments, research and submit medical records, review technical billing components, conduct telephone follow-up with payers, prepare initial bill packets, analyze account delinquencies, verify authorizations, file confidential documentation, manage inbound/outbound calls, appeal claim denials
Seniority
Junior to Mid-level, hands-on IC