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
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