Revenue Cycle Management Specialist

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs - everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals - because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

We are seeking a Revenue Cycle Management Specialist responsible for providing accurate, efficient billing services and supporting the management of medical claims. This role prepares and submits billing data and claims, verifies patient information, posts payments, reviews Electronic Remittance Advice (ERA), and helps ensure accounts are worked appropriately throughout the billing cycle.

The Revenue Cycle Specialist will review billing data to identify gaps, denial trends, and payment discrepancies and will communicate with colleagues, health plan staff, and other external stakeholders to resolve issues such as denials, takebacks, underpayments, and incomplete registrations. This individual will report to the Revenue Cycle Manager.

This role requires a detail-oriented and highly organized team member who can manage multiple priorities, adapt quickly, and deliver excellent service in a fast-paced, highly virtual environment. The Revenue Cycle Specialist must communicate effectively, both verbally and in writing, with colleagues located throughout the United States.

Skills Required:

At least 2 years of experience in medical billing or a similar role

Knowledge of ICD-10, CPT, and HCPCS coding

Solid understanding of billing software and electronic medical records (EMR); experience with Athena is preferred

Experience preparing and submitting medical claims and maintaining accurate patient billing information

Ability to post payments, review ERA activity, and identify denials or payment discrepancies

Ability to analyze and manage billing work queues, including open tasks, hold bills, alerts, and incomplete registrations

Strong analytical, critical-thinking, and problem-solving skills

Ability to multitask, prioritize work, and meet deadlines in a fast-paced environment

Excellent written, verbal, interpersonal, and customer service skills

Ability to work independently and collaboratively in a highly virtual environment

Proficiency in Microsoft Office, especially Excel; experience with Salesforce is preferred

Associate degree or high school diploma

Key Behaviors:

Prepare and submit accurate billing data and medical claims to insurance companies using appropriate coding

Confirm that patient medical and billing information is accurate and current

Prepare bills and invoices and document amounts due for medical procedures and services

Post payments, review ERA activity for accuracy, and notify the AR follow-up team of denials

Analyze denied claims and payment discrepancies and report recurring trends to management

Partner with colleagues and health plan staff to troubleshoot denials, takebacks, underpayments, and other billing concerns

Provide clear explanations of insurance claims, respond to patient inquiries, and escalate complex issues when necessary

Review Athena work queues to ensure accounts, correspondence tasks, hold bills, alerts, and incomplete registrations are properly assigned and addressed

Manage multiple priorities while completing high-priority work on time

Remain open to feedback, new ideas, changing priorities, and opportunities to learn and grow

Competencies:

Revenue Cycle and Billing Knowledge - Applies medical billing, claims, coding, payment posting, and EMR knowledge to support accurate billing operations.

Attention to Detail - Carefully validates patient information, coding, claims, invoices, payments, and work queue activity for completeness and accuracy.

Analytical Problem Solving - Reviews ERA data, denials, and payment discrepancies to identify issues, determine next steps, and escalate complex concerns appropriately.

Communication - Communicates clearly with patients, colleagues, health plan staff, and external stakeholders while providing responsive and professional support.

Organization and Adaptability - Balances multiple priorities, meets deadlines, works independently, and adjusts quickly as business needs change in a fast-paced environment.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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