Revenue Cycle Representative - Reconsiderations RCM

We’re seeking a Revenue Cycle Representative, Reconsiderations to join our RCM – Reconsiderations team and help ensure accurate, timely, and successful resolution of denied or underpaid claims through detailed research, follow‑up, and collaboration with payors.

As a Revenue Cycle Representative, Reconsiderations you will determine the acceptance of providers' payment through claims research, plans, eligibility and notes to determine if the payor owes payment to CareCentrix.

Identifies and escalates provider issues and concerns to the appropriate senior. Works under general supervision. Guides collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results.

In this role, you will:

• Ensure coordination of provider invoice activities to support timely reimbursement, using databases, online tools, and phone outreach.
• Research and resolve claim denials that fail payer edits, preparing corrections and appeals through electronic and paper processes.
• Verify patient eligibility, benefits, and health‑plan information using payer databases, CareCentrix eligibility systems, and medical documentation.
• Monitor and analyze invoice processing and payer responses using Windows‑based systems, Microsoft Excel, Microsoft Access, and other tools to ensure prompt payment.
• Support accounts receivable accuracy and process improvements by resolving overpayments, clearing variances, preparing corrected bills, and contributing to workflow enhancements.
• Collaborate and build strong relationships with internal and external partners—including providers, physicians, patients, and payer representatives—to obtain documentation, clarify requirements, and ensure successful reimbursement.

This role could be a great fit if you:

• Have a high school diploma or equivalent.
• Minimum of two (2) years of experience in medical claims processing and reimbursement within healthcare revenue cycle environment.
• Working knowledge of healthcare collections procedures and related internal and external claims processing software applications.
• Strong analytical, verbal, and written communication skills, with the ability to interpret payer requirements and resolve complex claim issues.
• Knowledge of HIPAA regulations, the Fair Credit and Collections Act, and medical billing and coding standards including HCPCS, CPT, and ICD‑9/ICD‑10.
• Familiarity with Utilization Management (UM) processes and URAC standards.
• Intermediate proficiency in Microsoft Office applications (Excel, Word, Access preferred) and ability to perform mathematical calculations related to billing, payments, and adjustments.
• Highly organized, detail‑oriented, and able to manage multiple priorities with strong time‑management skills in a fast‑paced environment.

• Pay Range: $18 - $20.00/ hour, plus corporate bonus incentive. This range reflects potential future growth and earning opportunities.
• Benefits: Medical, Dental, Vision, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more.
• Award-winning culture: Keeps our company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for Excellence; We Think BIG; We Take our Work Seriously, Not Ourselves.

CareCentrix maintains a drug-free workplace.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

Applications are accepted on an ongoing basis until a candidate is selected.