Enterprise Revenue Cycle Specialist

The Enterprise Revenue Cycle 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 escalate 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