AP Health · 7 hours ago
Revenue Cycle Specialist II
California, United States
Full-time
Hybrid
Senior Level
5+ years expAP Health is a healthcare provider focused on ensuring appropriate payment for services rendered. The Revenue Cycle Specialist II plays a critical role in managing claim denials and billing errors to protect revenue and enhance operational efficiency.
Health CareStaffing AgencyTraining
Responsibilities
Review and analyze unpaid and denied insurance claims to determine root causes, including coding inaccuracies, billing errors, authorization deficiencies, eligibility issues, payer policy conflicts, and medical necessity determinations, ensuring appropriate corrective action is identified
Research and interpret payer policies, contracts, coverage determinations, and clinical guidelines to support claim corrections and appeal strategies, including Medicare, Medicaid, and commercial insurance requirements
Prepare, submit, and track appeals, reconsiderations, and corrected claims in a timely and accurate manner, ensuring all submissions meet payer-specific documentation, formatting, and deadline requirements
Communicate directly with insurance carriers via phone, payer portals, and written correspondence to clarify denial reasons, obtain claim status updates, and advocate for appropriate reimbursement
Collaborate closely with coding, billing, and clinical teams to obtain, review, and submit supporting medical documentation, physician statements, and corrected coding as needed to support appeals
Maintain thorough and accurate documentation of all denial resolutions, appeal submissions, payer communications, and outcomes within the billing system to ensure audit readiness and reporting accuracy
Monitor claims filing and deadlines, payer response timelines, and follow-up requirements to ensure compliance with contractual, regulatory, and payer-specific timeframes
Identify recurring denial trends and systemic issues, analyze their financial and operational impact, and escalate findings to leadership with recommendations for process improvements and denial prevention strategies
Assist with denial prevention initiatives by providing feedback, education, and workflow recommendations to billing, coding, and clinical staff to reduce future denials
Stay current on federal and state regulations, CMS guidelines, and individual insurance company policies to ensure compliance and support accurate claims processing
Maintain detailed documentation of all claim actions, payer communications, and appeal outcomes to support audits and reporting
Qualification
Required
5-10 years in medical billing and claim denial management
Strong proficiency in Microsoft 365 (Outlook, Word, Excel, Teams, etc.), with the ability to quickly adapt to new tools and systems
Working knowledge of payer regulations and hospital billing processes
Familiarity with CPT, ICD-10, and HCPCS coding concepts
Experience using electronic health record (EHR) and/or medical billing software
Excellent verbal and written communication skills
Exceptionally proactive, organized, and detail oriented
Company
AP Health
AP Health is a staffing agency that provides trained and professional medical providers to hospitals and surgical clinics.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
J. Toby Gray
CEO
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