Revenue Cycle Systems Specialist

SanStone Health & Rehabilitation seeking a detail-oriented and technically proficient and proactive Revenue Cycle Systems Specialist to join our Revenue Cycle Department. This role is pivotal in managing and optimizing revenue cycle software systems, with a strong focus on maintaining and enhancing system functionality to support accurate payer records and efficient claims processing. The ideal candidate will possess deep expertise in healthcare billing platforms, demonstrate the ability to interpret and implement payer specifications within system frameworks, and contribute to the development of scalable solutions that improve operational workflows. A strong foundation in software logic, data integrity, and system troubleshooting is essential for success.

Key Responsibilities :

Billing Software System Management :

Provide ongoing support and management of revenue cycle systems

Create, maintain and update payer records

Obtain and manage payer rate and level changes

Payer Policy and Billing Support :

Research and communicate payer updates to relevant stakeholders

Organize and implement payer resources for departmental and company-wide use

Payer Compliance :

Conduct internal audits and review of internal processes.

Billing and Follow-Up :

Prepare and submit Medicare informational claims accurately and in compliance with Centers for Medicare & Medicaid Services (CMS) guidelines.

Conduct thorough follow-up on Medicare accounts receivable to ensure timely and complete payment.

Monitor and resolve denials, appeals, and underpayments related to Medicare claims.

Regional AR Specialist Support :

Provide support and backfill coverage for Regional Accounts Receivables (AR) Specialist as needed

Qualifications and Experience :

Minimum 2-year college or trade school degree

Minimum 2 to 3 years of recent healthcare billing and claims management experience, preferably in a skilled nursing facility or equivalent UB-04 billing environment.

Strong knowledge of billing software systems for insurance claims, preferably in MatrixCare or Point Click Care (PCC)

In-depth understanding of health insurance payers in a post-acute setting

In-depth working knowledge of Microsoft office specifically Word, Excel and PowerPoint

Insurance payer contract familiarity and understanding

Excellent written and verbal communication skills

Benefits :

At SanStone Health and Rehab, we offer employment opportunities in North Carolina that are filled with purpose.  We are an organization that is dedicated to making a difference in our industry and caring as passionately for our employees as we do our residents. SanStone Health and Rehab offers an excellent benefit package to full-time employees including PTO, medical, dental, vision, pharmacy and 401K plan with employer match.