Revenue Cycle Specialist - Prior Authorization and Claims

Pay: $21.56 - $24.57 per hourJob 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 ResponsibilitiesClaims & Billing ManagementPrepare, review, and submit insurance claims (Medicaid and other payers)Ensure all claim forms are completed accurately with no coding errorsVerify ICD-10, CPT, and HCPCS codes for proper reimbursementReview supporting documentation before claim submissionSubmit claims electronically and track claim statusDenials & AppealsInvestigate denied or rejected claimsPrepare appeal documentationCorrect coding or documentation errorsResubmit claims and follow up with payersDocumentation & ComplianceEnsure documentation meets payer and Medicaid requirementsMaintain organized billing records and claim documentationEnsure compliance with HIPAA and healthcare regulationsRevenue MonitoringTrack accounts receivableMonitor aging claimsIdentify patterns causing billing delays or denialsImprove billing workflows to maximize reimbursementRequired SkillsStrong knowledge of:ICD-10 codingCPT / HCPCS codesCMS claim formsMedical billing workflows*Experience handling claim denials and appealsExcellent organizational and documentation skillsHigh level of accuracy and attention to detailAbility to manage multiple claims and deadlines.Preferredbilling Medicaid waiver servicesExperience with EVV systems (Therap preferred)Healthcare provider agency experienceFamiliarity with New Jersey Medicaid billing rulesJob Type: Full-timeBenefitsHealth Care Plan (Medical, Dental & Vision)Retirement Plan (401k, IRA)Paid Time Off (Vacation, Sick & Public Holidays)

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