Revenue Cycle Specialist - TGH Access Operations

Supports oncology practices by managing day-to-day revenue cycle functions to ensure accurate billing, timely reimbursement, and regulatory compliance. Performs front-end and back-end revenue cycle activities including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial follow-up. Evaluates patient financial and insurance coverage, educates patients on financial responsibilities, and assists in securing financial assistance and external resources to support access to care. Maintains accurate billing logs, reimbursement references, and payer-specific guidelines in accordance with state and federal regulations. Reviews documentation requests, resolves charge rejections and denials, and coordinates with billing offices and claims teams to ensure timely claim submission and resubmission. Develops and maintains patient tracking and financial reporting tools to support reimbursement accuracy and operational visibility. Acts as a knowledgeable resource for revenue cycle processes, oncology reimbursement requirements, and compliance standards, contributing to process improvements that enhance efficiency while minimizing financial and legal risk.

Essential Functions

• Oversee front-end and back-end processes including insurance verification, benefit analysis, charge capture, billing, payment posting, and denial resolution.
• Maintain adherence to state and federal healthcare regulations (CMS, Medicare, Medicaid) and payer-specific guidelines to minimize financial and legal risk.
• Confirm patient coverage, analyze benefits, and secure authorizations to ensure accurate billing and timely reimbursement.
• Communicate cost estimates, explain co-pays, deductibles, and assist patients in accessing financial assistance programs.
• Validate referrals, diagnosis codes, and procedure codes; resolve charge rejections and coordinate with billing teams for timely claim submission.
• Investigate and correct claim denials and rejections, ensuring resubmission within payer timelines.
• Develop and update patient tracking systems, billing logs, and financial reporting tools to support operational visibility.
• Serve as a resource for oncology reimbursement requirements, compliance standards, and best practices in revenue cycle management.
• Identify opportunities to enhance workflow efficiency, reduce errors, and optimize reimbursement outcomes.
• Other duties as assigned.

Education Qualifications

• Associate’s Degree Business
• Associate’s Degree Finance
• Associate’s Degree Accounting
• Associate’s Degree Related Field

Experience Qualifications

• A minimum of 2-3 years of experience working within a medical billing department.
• An equivalent combination of education/certification and realized competencies can substitute for the required education

Skills and Abilities

• Ability to manage front-end and back-end processes including insurance verification, charge capture, billing, payment posting, and denial resolution.
• Skilled in confirming coverage, analyzing benefits, and ensuring financial clearance.
• Strong knowledge of medical coding systems: CPT, HCPCS, and ICD-10, and their application in oncology services.
• Payer-Specific Authorization and Medical Necessity Requirements
• In-depth knowledge of state and federal healthcare regulations (CMS, Medicare, Medicaid, and commercial insurance compliance standards).
• Knowledge of authorization processes, medical necessity criteria, and reimbursement guidelines.
• Ability to analyze, resolve, and prevent claim denials and rejections.
• Skilled in explaining financial responsibilities and assisting with financial assistance programs.
• Competence in reviewing referrals, diagnosis, and procedure codes for accurate billing.
• Ability to develop and maintain patient tracking systems and financial reporting tools.