[Hiring] Revenue Cycle Billing Specialist @Firstsource

Role Description

The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives reimbursement from government and commercial payers. The ideal candidate has strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.

• Claim Follow-Up – PB & HB
  • Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone calls, payer websites, and Epic work queues to ensure timely reimbursement.
  • Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments.
  • Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
  • Identify payer trends and payment discrepancies across both PB and HB claim types and escalate findings to leadership.
  • Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable.
  • Escalate claims with payers for resolution on inaccurate or delayed claim processing.
• Appeals & Reconsiderations
  • Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification.
  • Adhere to payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.
• Payer & System Knowledge
  • Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data.
  • Utilize payer portals (Availity, NaviMedix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs.
  • Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.
• Compliance & Documentation
  • Ensure accurate and detailed documentation of all follow-up activities in Epic.
  • Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections.
  • Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies.
  • 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.

Qualifications

• High school diploma or equivalent required.
• Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred.

Requirements

• 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up.
• Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up.
• Prior experience with Epic billing and/or follow-up work queues strongly preferred.
• Familiarity with Medicaid, Medicare, and commercial payers preferred.
• Experience reading and interpreting 835 ERA / EOB remittance data.

Competencies & Skills

• Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes.
• Proficiency with Epic (HB and/or PB modules, work queues, claim correction, and rebilling).
• Familiarity with CARC/RARC denial and adjustment reason codes.
• Ability to interpret EOB, ERA (835), and 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

• Medical
• Vision
• Dental
• 401K
• Paid Time Off