Specialist, Revenue Cycle

Specialist, Revenue Cycle

Your Role...

As a Specialist, Revenue Cycle, you will independently perform day-to-day revenue cycle activities for Morlen Health programs, including insurance eligibility and benefits verification, prior authorization management, coding support, charge entry, claims processing, and routine denial resolution. You will apply established revenue cycle practices and payer requirements to resolve routine issues, support accurate and timely reimbursement, and reduce administrative barriers to patient access.

Working across Patient Services, clinical leadership, Finance, referring providers, and insurance payers, you will identify revenue cycle trends and workflow opportunities and recommend improvements. As Morlen Health expands into additional commercial payer relationships, programs, and markets, you will contribute to the development and implementation of scalable revenue cycle processes.

This is a full-time, remote position.

In This Role, You Will...

• Independently perform routine day-to-day revenue cycle activities in accordance with organizational procedures, payer requirements, and established controls.
• Conduct patient eligibility and benefits verification and determine required administrative next steps.
• Manage prior authorization and referral requirements from initiation through completion, including monitoring expiration dates, outstanding information, and renewal needs.
• Review documentation for billing readiness and coordinate resolution of routine documentation deficiencies before charge entry and claim submission.
• Complete accurate and timely charge entry in system based on documented services and established coding protocols.
• Prepare and submit claims and monitor them throughout the revenue cycle, researching and resolving routine claim edits, rejections, and denials.
• Communicate directly with insurance payers to investigate billing, authorization, reimbursement, and claim issues.
• Apply established coding protocols and documentation standards to pulmonary rehabilitation and related services, including assigning CPT codes based on clinical documentation and established practices.
• Coordinate with referring provider offices to obtain documentation required for authorization, billing, and patient onboarding.
• Assist patients and caregivers with routine questions regarding coverage, benefits, authorization requirements, and administrative status.
• Monitor revenue cycle performance measures, identify trends and recurring issues, and communicate significant findings to appropriate stakeholders.
• Recommend practical process and workflow improvements and support implementation of approved changes.
• Develop and maintain payer-specific workflows and operational reference materials.
• Collaborate with Patient Services, clinical leadership, Finance, referring providers, and payer representatives to support accurate information flow and continuity of revenue cycle activities.

What You Need to Be Successful...

1. 3+ years of experience in healthcare revenue cycle, medical billing, patient access, healthcare operations, or a related healthcare administrative function.
2. Experience independently performing multiple components of the revenue cycle, such as eligibility and benefits verification, prior authorizations, charge entry, claim submission, claim follow-up, or denial resolution.
3. Experience working with electronic medical record, practice management, or healthcare billing systems.
4. Experience researching and resolving routine payer, billing, authorization, or reimbursement issues.
5. Working knowledge of healthcare revenue cycle processes, medical terminology, medical billing practices, and CPT and ICD-10 coding concepts.

Strong analytical and problem-solving skills with the ability to research revenue cycle issues and determine appropriate next steps.

1. Strong attention to detail and the ability to independently manage competing priorities, follow-up activities, and deadlines.
2. Sound judgment and the ability to recognize when clinical, contractual, compliance, policy, or leadership escalation is needed.
3. Strong written and verbal communication skills and the ability to collaborate effectively with clinical, operational, financial, patient, provider, and payer stakeholders.
4. Proficiency with Microsoft Office and web-based healthcare applications.

Preferred:

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Health Information Management, or a related field.
• American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) certification.
• Experience with Athenahealth.
• Experience with commercial insurance plans and Medicare.
• Experience with insurance verification and prior authorizations.
• Experience in pulmonary rehabilitation, cardiopulmonary medicine, rehabilitation, or an outpatient specialty practice.

Your Compensation...

The annual salary range for this position is $19.65-33.50 per hour. Actual compensation will be determined based on factors such as an applicant’s skills and qualifications, education and certifications, training, relevant experience, market data, geographic location, internal equity, and other job-related factors. In addition to base salary, Morlen Health offers a comprehensive benefits package that includes medical, dental, and vision coverage; retirement benefits; paid time off; paid holidays; and other benefits and programs. Specific details are below, and specific plan information is available upon request.

Your Benefits & Perks...

• Medical coverage with HMO and POS plan options; employee-only coverage is 100% employer paid for eligible full-time employees.
• Dental and vision coverage, including preventive dental care, orthodontia benefits, annual eye exams, eyewear and contact lens allowances, and vision discounts.
• Health Care and Dependent Care Flexible Spending Accounts (FSAs) for eligible expenses.
• Employer-provided short- and long-term disability coverage.
• 401(k) retirement savings plan with a broad range of investment options and retirement planning resources.
• Paid time off and company-paid holidays.
• Employee Assistance Program (EAP) with confidential emotional health, work-life, legal, financial, childcare, eldercare, and wellness resources for employees and household members.
• Voluntary supplemental benefits, including accident, critical illness, and hospital indemnity coverage.
• Dedicated benefits support through ADP TotalSource MyLife Advisors.

About Morlen Health

Morlen Health was created by the physicians of Northwest Permanente PC to create, protect, and grow innovative healthcare solutions for their patients and communities. We have a relentless focus on best-in-class quality patient care and outcomes. Morlen Health is dedicated to delivering affordable, high-quality healthcare at individual and population levels. Through our population health services and digitally enabled solutions, we are working to improve access, engagement, health outcomes, and the overall care experience.