ASC Revenue Cycle Management (RCM) Specialist Permanent WFH

We are seeking an experienced Revenue Cycle Management (RCM) Specialist to support the financial and billing operations of an Ambulatory Surgery Center (ASC). This role is responsible for managing key revenue cycle functions, including insurance verification, medical billing, payment posting, accounts receivable, denial management, collections, and payer follow-up.

The ideal candidate has hands-on experience with ASC medical billing and coding, understands Medicare and third-party payer requirements, and can effectively identify and resolve issues that may delay or prevent reimbursement. This position requires strong attention to detail, analytical thinking, and the ability to manage multiple priorities while maintaining accurate patient and insurance accounts.

Key Responsibilities

Insurance Verification & Medical Billing

• Verify patient insurance eligibility, benefits, coverage, and authorization requirements.
• Review and maintain accurate patient demographics, insurance information, and billing details.
• Identify eligibility, authorization, and coverage issues and coordinate with appropriate staff to resolve them.
• Prepare and submit accurate and timely medical claims in accordance with payer requirements.
• Monitor clearinghouse submissions, rejections, and payer acknowledgments.
• Research and correct claim errors, including demographic, coding, billing, and eligibility issues.
• Submit secondary claims when appropriate, including claims that do not automatically cross over from Medicare.
• Monitor clean claim rates and other RCM performance metrics.
• Coordinate with clinical and administrative staff to obtain outstanding operative reports or documentation required for billing.
• Apply contractual adjustments according to payer contracts and established procedures.
• Maintain working knowledge of Medicare billing regulations, CCI edits, bundling rules, ASC fee schedules, and third-party payer requirements.
  
  

Payment Posting & Reconciliation

• Post insurance payments from EFTs, checks, and other payment sources accurately and promptly.
• Post patient payments, contractual adjustments, and other account adjustments.
• Reconcile payment batches and investigate payment discrepancies.
• Maintain accurate patient and insurance account ledgers.
• Review and resolve credit balances in accordance with established procedures.
• Ensure payments and adjustments are applied to the correct accounts and claims.
• Maintain complete documentation of payment activity and account resolution.
• Escalate significant payment discrepancies or posting issues to management.
  
  

Accounts Receivable & Denial Management

• Manage and work insurance and patient accounts across all AR aging categories.
• Follow up with insurance carriers on unpaid, underpaid, delayed, and outstanding claims.
• Research zero-pay claims and determine the reason for nonpayment.
• Manage claim denials through clearinghouses and payer portals.
• Submit corrected claims and appeals when appropriate.
• Track and follow up on high-dollar claims and other significant outstanding balances.
• Research and resolve billing, coding, payment, and reimbursement issues.
• Maintain accurate AR notes and account documentation.
• Monitor AR reports and communicate significant variances, payer trends, and collection concerns to management.
• Identify recurring issues affecting reimbursement and recommend opportunities for process improvement.
• Manage tissue reimbursement and other applicable reimbursement-related issues.
  
  

Patient Accounts & Collections

• Review patient accounts and ensure statements are generated according to established procedures.
• Respond professionally to patient questions regarding billing, balances, payments, and account activity.
• Accept and accurately post patient payments.
• Explain account balances and payment information within the scope of the position.
• Research and resolve patient account discrepancies.
• Handle financial concerns and collection-related conversations professionally.
• Maintain strict confidentiality of patient and financial information.
  
  

General Business Office Support

• Assist with additional business office functions as needed, including scheduling, admitting, data entry, medical records, filing, mailing, and other administrative activities.
• Organize daily responsibilities according to priority and established deadlines.
• Maintain current knowledge of payer policies, reimbursement requirements, and changes affecting ASC billing.
• Participate in the development and improvement of business office policies and procedures.
• Support initiatives focused on improving revenue cycle performance, accuracy, efficiency, and reimbursement.
• Maintain accurate records and documentation in accordance with organizational policies.
  
  

Qualifications

• Minimum of 2 years of healthcare RCM, medical billing, insurance verification, payment posting, or accounts receivable experience preferred.
• Previous ASC medical business office experience strongly preferred.
• Previous medical billing and/or coding experience required.
• Strong understanding of medical billing and revenue cycle processes.
• Knowledge of Medicare and third-party payer rules and regulations.
• Knowledge of insurance eligibility, benefits, payer contracts, and reimbursement requirements.
• Understanding of medical coding concepts, CCI edits, and bundling rules.
• Knowledge of ASC facility billing and ASC fee schedules.
• CPC certification is highly desirable.
• Knowledge of patient and insurance collection processes.
• Familiarity with Waystar, payer portals, Medicare portals, and other electronic billing resources.
• Experience with SIS/Vision Source Medical is preferred.
• Proficiency with Microsoft Office Suite.
• Strong knowledge of medical terminology.
• Must be able to provide proof of identity and authorization to work in the United States.
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.