Sr. Revenue Cycle Billing Specialist (Remote, Remote, US)

About this role

Role Description

The Revenue Cycle Denials Representative is responsible for managing and resolving denied Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role identifies root causes of denials, executes appeals and corrective actions, and collaborates with internal teams to prevent future denials. The ideal candidate has hands-on experience with CARC/RARC denial codes, Epic denial work queues, and payer-specific appeal requirements across Medicare, Medicaid, and commercial payers.
Roles & Responsibilities

Denial Review & Resolution – PB & HB

• Review and analyze denied PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims to determine root causes and appropriate resolution strategies.

• Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.

• Work claims across all top denial categories including, but not limited to: No Authorization, Timely Filing, Coordination of Benefits (COB), Medical Necessity, Additional Documentation Requests (ADR), Bundling (NCCI edits), and Duplicate Claims.

• Interpret CARC and RARC codes on 835 ERA / EOB remittance data for both PB and HB claims to determine the correct resolution path.

• Understand when claim corrections, rebilling (837P or 837I), or void-and-replace actions are appropriate.

• Escalate claims with payers for resolution when processing is inaccurate or delayed.

Appeals & Reconsiderations

• Prepare and submit appeals and reconsideration requests in compliance with payer-specific guidelines and deadlines for both PB and HB denied claims.

• Attach appropriate clinical documentation, medical records, authorization references, and justification letters to support appeal submissions.

• Meet appeal deadlines for Medicare, Medicaid, and commercial payers in accordance with payer-specific requirements.

Trend Identification & Prevention

• Identify denial trends across PB and HB claim types and collaborate with coding, clinical, and billing teams to implement corrective actions.

• Monitor payer policy and regulatory changes (Medicare LCDs/NCDs, Arkansas Medicaid updates) to proactively prevent denials.

• Assist in developing best practices and training materials for PB and HB denial management and prevention.

Payer & System Knowledge

• Navigate Epic denial and underpayment work queues for both HB and PB modules; document all denial actions and resolutions.

• Utilize payer portals (Availity, Arkansas DHS, Medicare.gov, and commercial payer sites) to research denial reasons and submit appeals.

• Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.

Compliance & Documentation

• Maintain thorough documentation of denial reasons, appeal actions, and resolutions in Epic.

• Ensure compliance with federal, state, and payer regulations as well as hospital and physician practice policies.

• Communicate effectively with insurance representatives and internal leaders to expedite resolution and improve processes.

• Always maintain confidentiality of patient and account information (HIPAA).

• Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct.

• Maintain awareness of and actively participate in the Corporate Compliance Program.

• Maintain a confidential and orderly remote work area.

• Meet specified goals and objectives assigned by management and/or the Client.

• Assist with other projects as assigned by management.

Expected / Key Results

• Deliver high levels of client and patient satisfaction (CSAT)

• Achieve quality scores per defined process standards

• Deliver defined process-specific metrics (e.g., denial resolution rate, overturn rate, appeal success rate)

• Adherence to regulatory compliance requirements

• Schedule adherence

Preferred Educational Qualifications

• High school diploma or equivalent required

• Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred

• CPC, CPMA, CRCR, or CHFP certification a plus

Preferred Work Experience

• 2+ years of experience in healthcare revenue cycle, denial management, or claims resolution

• Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) denials

• Prior experience with Epic denial work queues strongly preferred

• Familiarity with Medicaid, Medicare, and commercial payers preferred

• Experience interpreting CARC/RARC codes and 835 ERA / EOB remittance data

• Knowledge of NCCI edits, LCD/NCD policies, and authorization/pre-certification workflows

Competencies & Skills

• Strong knowledge of PB and HB denial workflows, appeal processes, and payer-specific requirements

• Proficiency with Epic (HB and/or PB modules, denial work queues, claim correction, void-and-replace, and rebilling)

• Solid understanding of CARC/RARC denial reason codes and how to act on them for PB and HB claims

• Ability to read and interpret 835 ERA / EOB remittance advice for both PB and HB claims

• Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites

• Competent in working and communicating effectively with payers, patients, colleagues, and management – both in-person and via remote virtual platforms

• Consistently maintains a courteous and professional demeanor

• Self-motivated with the ability to stay focused and productive with minimal supervision

• Proactive initiative and creative problem-solving in carrying out job responsibilities

• Ability to prioritize multiple tasks through effective time management and organizational skills

• Proficiency in PC operations; ability to type at a rate of 30–40 words per minute

Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.
We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity,…