Enterprise Revenue Cycle Specialist
Joriehc, Oak Brook, IL, United States
The Claims Resolution Specialist is responsible for managing Accounts Receivable and resolving clearinghouse rejections across multiple specialties and clients. This role requires deep end to end revenue cycle knowledge, with a primary focus on claim correction, payer follow up, and driving timely reimbursement.
This individual operates in a high volume, multi client environment and is expected to work independently, identify root causes, and reduce rework through accurate and efficient resolution of claim issues.
Core Responsibilities
Accounts Receivable Management
Perform timely follow up on outstanding AR across all aging buckets
Analyze unpaid claims, identify root causes, and take appropriate action to drive resolution
Work denials, rejections, and underpayments including corrections, resubmissions, and escalations
Ensure proper documentation of all actions taken within the practice management system
Prioritize accounts based on aging, dollar value, and payer specific trends
Clearinghouse Rejection Resolution
Review and correct clearinghouse rejections daily to ensure clean claim submission
Identify trends in rejection types and implement corrective actions to reduce recurrence
Validate claim data including demographics, coding, modifiers, and payer requirements
Resubmit corrected claims within defined turnaround times
Claims & Billing Accuracy
Ensure claims are billed in accordance with payer guidelines and client specific rules
Validate coding, modifiers, and required data elements prior to submission
Collaborate with front end and coding teams to resolve upstream issues impacting claim quality
Root Cause Analysis & Process Improvement
Identify patterns in denials and rejections and elevate systemic issues
Provide feedback to leadership on workflow gaps, payer trends, and process breakdowns
Support initiatives focused on reducing AR days, denial rates, and rework
Cross Functional Collaboration
Partner with internal teams including QA, Automation, and Client Success to resolve issues
Communicate effectively with clients when required to clarify billing or payer requirements
Adapt to multiple EMRs, clearinghouses, and payer systems across clients
Required Qualifications
Minimum 5 plus years of experience in Revenue Cycle Management with strong focus on AR follow up and claims or rejections
Proven experience working clearinghouse rejections and payer denials across multiple specialties
Strong understanding of the full revenue cycle including billing, coding fundamentals, and payer guidelines
Experience working with multiple EMRs and clearinghouses such as Availity, Change Healthcare, Waystar or similar
Ability to manage high volume workloads while maintaining accuracy and productivity standards
Strong analytical and problem-solving skills
Preferred Qualifications
Multi-specialty experience including radiology, ophthalmology, or surgical practices
Experience in a multi-client or outsourced RCM environment
Familiarity with automation tools or workflow optimization initiatives
Key Performance Indicators
AR resolution rate and reduction in aging
Clearinghouse rejection turnaround time
Denial resolution rate and rework reduction
Productivity and quality accuracy scores
Contribution to overall cash acceleration and revenue recovery
Work Environment
Fast-paced, metrics driven environment supporting multiple clients
Requires adaptability across systems, workflows, and payer requirements
Strong emphasis on accountability, accuracy, and continuous improvement
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This individual operates in a high volume, multi client environment and is expected to work independently, identify root causes, and reduce rework through accurate and efficient resolution of claim issues.
Core Responsibilities
Accounts Receivable Management
Perform timely follow up on outstanding AR across all aging buckets
Analyze unpaid claims, identify root causes, and take appropriate action to drive resolution
Work denials, rejections, and underpayments including corrections, resubmissions, and escalations
Ensure proper documentation of all actions taken within the practice management system
Prioritize accounts based on aging, dollar value, and payer specific trends
Clearinghouse Rejection Resolution
Review and correct clearinghouse rejections daily to ensure clean claim submission
Identify trends in rejection types and implement corrective actions to reduce recurrence
Validate claim data including demographics, coding, modifiers, and payer requirements
Resubmit corrected claims within defined turnaround times
Claims & Billing Accuracy
Ensure claims are billed in accordance with payer guidelines and client specific rules
Validate coding, modifiers, and required data elements prior to submission
Collaborate with front end and coding teams to resolve upstream issues impacting claim quality
Root Cause Analysis & Process Improvement
Identify patterns in denials and rejections and elevate systemic issues
Provide feedback to leadership on workflow gaps, payer trends, and process breakdowns
Support initiatives focused on reducing AR days, denial rates, and rework
Cross Functional Collaboration
Partner with internal teams including QA, Automation, and Client Success to resolve issues
Communicate effectively with clients when required to clarify billing or payer requirements
Adapt to multiple EMRs, clearinghouses, and payer systems across clients
Required Qualifications
Minimum 5 plus years of experience in Revenue Cycle Management with strong focus on AR follow up and claims or rejections
Proven experience working clearinghouse rejections and payer denials across multiple specialties
Strong understanding of the full revenue cycle including billing, coding fundamentals, and payer guidelines
Experience working with multiple EMRs and clearinghouses such as Availity, Change Healthcare, Waystar or similar
Ability to manage high volume workloads while maintaining accuracy and productivity standards
Strong analytical and problem-solving skills
Preferred Qualifications
Multi-specialty experience including radiology, ophthalmology, or surgical practices
Experience in a multi-client or outsourced RCM environment
Familiarity with automation tools or workflow optimization initiatives
Key Performance Indicators
AR resolution rate and reduction in aging
Clearinghouse rejection turnaround time
Denial resolution rate and rework reduction
Productivity and quality accuracy scores
Contribution to overall cash acceleration and revenue recovery
Work Environment
Fast-paced, metrics driven environment supporting multiple clients
Requires adaptability across systems, workflows, and payer requirements
Strong emphasis on accountability, accuracy, and continuous improvement
#J-18808-Ljbffr