AP Health · 4 hours ago
Revenue Cycle Specialist III
Nashville, TN
Full-time
Hybrid
Mid Level
3+ years expAP Health is a healthcare organization seeking a Revenue Cycle Specialist III to manage payment posting and reconciliation processes. This role is critical in ensuring accurate account balances and compliance with payer contracts while collaborating with various teams to resolve discrepancies.
Health CareStaffing AgencyTraining
Responsibilities
Accurately post insurance payments, patient payments, contractual adjustments, and refunds to patient accounts in a timely manner, ensuring all transactions are applied to the correct encounter, date of service, payer, and provider in accordance with payer contracts and organizational policies
Review and interpret Explanation of Benefits (EOBs) and payer correspondence to validate payment amounts, identify contractual allowances, and ensure proper application of payments, adjustments, coinsurance, deductibles, and patient responsibility
Identify, analyze, and appropriately route underpayments, overpayments, denials, partial payments, and zero-pay claims to the appropriate teams, documenting findings and attaching supporting payer documentation as needed
Reconcile posted payments and adjustments with bank and billing system totals by researching variances, correcting posting errors, and escalating unresolved discrepancies
Apply payer-specific contractual adjustments accurately using established fee schedules, contracts, and payer reimbursement guidelines, ensuring compliance with negotiated rates, and identifying variances
Process refunds, credit balances, and payment reversals in accordance with internal policies, payer requirements, and regulatory guidelines, including verifying refund eligibility, obtaining required approvals, and documenting actions taken
Maintain detailed and accurate documentation of all payment activity, including posting actions, corrections, correspondence, and reconciliation efforts, to support audits, reporting, and internal controls
Collaborate closely with billing, denial management, and finance teams to resolve posting issues, clarify payment discrepancies, and support timely resolution of account balances
Ensure full compliance with HIPAA, payer guidelines, contractual obligations, and organizational policies when handling protected health information and financial data
Qualification
Required
3 to 5 years of experience in medical billing, cash posting, or revenue cycle 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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