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Revenue Cycle Specialist - Prior Authorization and Claims
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Job Description
- Req#: EA8DB570F8
- Prepare, review, and submit insurance claims (Medicaid and other payers)
- Ensure all claim forms are completed accurately with no coding errors
- Verify ICD-10, CPT, and HCPCS codes for proper reimbursement
- Review supporting documentation before claim submission
- Submit claims electronically and track claim status
- Investigate denied or rejected claims
- Prepare appeal documentation
- Correct coding or documentation errors
- Resubmit claims and follow up with payers
- Ensure documentation meets payer and Medicaid requirements
- Maintain organized billing records and claim documentation
- Ensure compliance with HIPAA and healthcare regulations
- Track accounts receivable
- Monitor aging claims
- Identify patterns causing billing delays or denials
- Improve billing workflows to maximize reimbursement
- Strong knowledge of:
- ICD-10 coding
- CPT / HCPCS codes
- CMS claim forms
- Medical billing workflows
- Experience handling claim denials and appeals
- Excellent organizational and documentation skills
- High level of accuracy and attention to detail
- Ability to manage multiple claims and deadlines.
- billing Medicaid waiver services
- Experience with EVV systems (Therap preferred)
- Healthcare provider agency experience
- Familiarity with New Jersey Medicaid billing rules
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Paid Time Off (Vacation, Sick & Public Holidays)
Pay: $21.56 - $24.57 per hour
Job description:
We are seeking a highly organized and detail-oriented Revenue Cycle Specialist to manage the full lifecycle of healthcare claims-from documentation review and coding to claim submission, denial management, and payment reconciliation.
The ideal candidate has strong experience with Medicaid billing, ICD/CPT coding, claim documentation, and resolving denials, ensuring all claims are submitted accurately and promptly.
Key Responsibilities
Claims & Billing Management
Denials & Appeals
Documentation & Compliance
Revenue Monitoring
Required Skills
Preferred
Job Type: Full-time
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