Revenue Cycle Coordinator

Job Description

Posted on: 
December 6, 2023

RPM, a Modivcare company, is looking for a Revenue Cycle Coordinator who will be responsible for billing effectively and efficiently to facilitate prompt payment for services via billing systems and developing collaborative relationships with payor’s billing departments. This role will be able to perform (one or more) of the following tasks (related to billing method or status of claim management). Including verifying client eligibility, monthly submissions, resubmissions or back billing, resolve denied or rejected claims, including researching accounts, analyzing EOBs, and interacting with insurance companies and government payors.


  • Utilize the phone system application by logging in and setting a status of ready to manage incoming phone calls by responding to request and assisting with inquiries.
  • Identify and research eligibility through multiple web portals, collects needed information to ensure timely processing of electronic, portal, and invoiced claims.
  • Follow revenue cycle processes from charge creation through resolution of outstanding AR.
  • Monitor AR related to service authorizations to ensure payment.
  • Verify eligibility when required prior to billing payers and documents insurance verification.
  • Generate monthly charges and transmission of assigned claim groups.
  • Assist in investigating and resolving claim rejections and denials via Clearinghouse or payer portals.
  • Utilize payer portals or contact payers as needed for claim corrections and/or missing information.
  • Add and understand specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-10 coding.
  • Apply corrections to patient demographics, charges, adjustments, and payments or when needed forwards to the appropriate department for correction.
  • Handle reporting cards and tickets assigned through company applications.
  • Handle rejection and denial workgroups for timely review and resubmission of EDI claims.
  • Assist with resolving problems by clarifying issues, researching potential solutions, helping to implement changes to maximize timely and complete reimbursement, and escalating unresolved issues.
  • Utilize multiple system applications daily to work through assigned inventory.
  • Identify and documents any payer issues and communicate with RCM leadership.
  • Audit and validates all billing functions to reduce potential fraud and incorrect billing.
  • Update and cross checks all billing procedure codes in the system.
  • Provide subject matter expertise in all systems utilized in the Revenue Cycle to aid in learning and process improvement.
  • Follow SOX compliance within systems as outlined.
  • Perform resubmission projects and additional daily reports.
  • Participate in other projects or duties as assigned.

Job Requirements

  • High School Diploma required.
  • Zero (0) plus years of experience.
  • Or equivalent combination of education and/or experience.
  • Strong attention to detail and accuracy.
  • Basic understanding of claims, billing and invoicing processes.
  • Proficient in the use of computer software and data entry.
  • Excellent written and verbal communication and interpersonal skills.
  • Ability to work effectively in a team-oriented environment.
  • Basic problem-solving skills.
  • Time management and organizational abilities, ability to manage multiple tasks.
  • Customer service-oriented mindset.
  • Self-motivation and the ability to work independently and with teams.
  • Literate in healthcare, specifically in Medicaid and Medicare Advantage environments.
  • Ability to handle highly sensitive data with confidentiality and integrity.
  • Proficient in the use of Word, Excel, Outlook, and PowerPoint.

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