Revenue Cycle Specialist - Medicare and Medicaid

We are recruiting for a mission-driven Revenue Cycle Specialist - Medicare and Medicaid to join our team!

We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values

Respect | Belonging | Accountability | Transparency

Department

Billing and Collections

Job Summary

Under general supervision, the Specialist ensures optimal reimbursement for hospital or provider billing on inpatient and outpatient accounts. Provides customer service, billing, timely follow-up, cash application processes, reconciling payer remittance, denial management and appeal functions for claims to government or grant funded programs, worker's compensation, commercial insurance. Provides financial guidance on self-pay accounts. Interprets explanation of benefits. Investigates delinquent accounts for legal liability. Acts as liaison support between the Hospital and Physician Business Services departments and third-party payers and other Denver Health departments. Utilizes various software applications and information systems to perform work processes.

Essential Functions:

• Completes claims submissions, performs review of accounts, ensure that work performed is accurate and complete. Consistently documents contact with debtor/insurance and/or any other content to the account using appropriate methods. Reviews account information and make necessary changes. Researches, corrects, and resubmits claims within the mandated time frames to avoid loss of revenue. Initiates collections by contacting third party payer/debtor or designated representative. If assigned to cash applications assures that payments are posted and reconciled timely (40%)
• Returns assignments within the appropriate timeframe and with suggestions for resolution or process improvement. Completes worklists as assigned. Work product is consistently of high quality. Staff QA’d weekly and must be at 97% or higher. (20%)
• Uses billing systems efficiently and appropriately. Follows and understands actions needed to correctly effect patient accounts with the Siemens Invision system. Utilizes the imaging system to perform needed account research; able to scan, import and export if needed. Uses eligibility software to ensure the correct payer is billed. (15%)
• Processes accounts transactions accurately that involve transfer of charges, combining accounts, or manual adjustments. (10%)
• Processes and responds to incoming correspondence from insurance carriers, patients, and other Denver Health departments to move the accounts toward resolution. (10%)
• Identifies and communications existing or potential problems to supervisor in a timely manner. Offers constructive actions in problem resolution. (5%)

Education:

• High School Diploma or GED Required
• Associate's Degree Preferred

Work Experience:

• 1-3 years Experience in a hospital or clinic revenue cycle setting Required
• 1-3 years

Licenses:

Knowledge, Skills and Abilities:

• Knowledge and understanding of insurance benefit plans and explanation of benefits.
• Have current knowledge of regulatory requirements and codes.
• Skill sets to include 10-key by touch, typing a minimum of 25 words per minute (WPM) and, basic skills in word processing and spreadsheet applications.
• Ability to prioritize work activities with minimal supervision, in an individual and team setting.
• Strong written and verbal communication skills, analytical thinking, high level of computer accuracy, and organization and problem solving skills.
• Ability to utilize various software applications and information systems to perform work processes.
• Ability to adapt easily to change.
• Ability to read and understand the payer explanation of payment

Shift

Work Type

Regular

Salary

$22.71 - $31.79 / hr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit prog