CCS Medical

Revenue Cycle Specialist

Position Status
Regular Full-Time
Position Schedule
8 am - 5 pm


Responsible for claim submission and  claim resolution for CCS Medical patients in regards to governmental, commercial insurance companies and patient accounts.  


Essential Duties:

  • Works individual portfolio of accounts from CCS Medical billing/collection system
  • Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
  • Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
  • Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
  • Researches and follow up on all correspondence associated with assigned accounts, including EOB's and documentation letters and generate correspondence requesting required information when necessary
  • Initiates appeals and ensures all required documentation is submitted in the appeals process. Researches all denials and follow up as necessary.
  • Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds 
  • Reduces delinquent accounts and achieeving maximum collections from all sources
  • Produces reports identifying trends or problem carriers and identify areas of concern and present ideas to correct or prevent furture issues
  • Analyzes and correct accounts receivable problems
  • Posting payments and/or adjustments to individual accounts
  • Resolving credit balance accounts as needed
  • Documents all activities as completely as possible
  • Achieves productivity goals based on accounts touched, dollars collected and solutions for work improvement or problem solution
  • Maintains a high degree of confidentiality at all times due to access to sensitive information
  • Maintains regular, predictable, consistant attendance and is flexible to meet the needs of the department
  • Follows all Medicare, Medicaid, HIPAA and Private Insurance regulations and requirements
  • Abides by all regulations, policies, procedures and standards

Performance Responsibilities:

  • Exercises appropriate cost control measures
  • Maintains positive internal and external customer service relationships
  • Maintains open lines of communication
  • Plans and organizes work effectively and ensures its completion
  • Meets all productivity requirements
  • Demonstrates team behavior and promotes a team-oriented environment
  • Actively participates in Continuous Quality Improvement
  • Represents the organization professionally at all times


Position Requirements & Compentencies:

  • High school diploma or GED equivalent
  • Minimum of two years of medical billing/collections experience necessary. Must be knowledgeable of reimbursement processes and procedures.
  • Ability to work with other employees and provide assistance as needed
  • Proficient in basic PC skills (MS Office)
  • Organized work habits, accuracy and proven attention to detail with strong analytical skills
  • Ability to work within a team setting and as an individual contributor
  • Excellent oral and written communication skills
  • Self-directed with the ability to work with little or no supervision
  • Flexible and cooperative in fulfillin all obligations
  • Ability to interpret rules and regulations set by Medicare, Medicaid and Commercial payors

                                                                                                                                           Equal Opportunity Employer/Veterans/Disabled


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