SUMMARY/OBJECTIVES

The Revenue Cycle Coordinator is responsible for coordinating, monitoring, and supporting the daily operations of the Revenue Cycle Department to ensure accurate patient registration, insurance verification, credentialing, coding support, claims processing, payment posting, denial management, collections, and provider enrollment activities. This position serves as a key resource in maintaining efficient revenue cycle workflows that maximize reimbursement while ensuring compliance with federal and state regulations, payer requirements, accreditation standards, and organizational policies.

The Revenue Cycle Coordinator works closely with clinical leadership, providers, finance, credentialing entities, insurance payers, to improve operational performance, reduce claim denials, improve cash flow, and support the overall financial health of Edgewater Health.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to, the following:

Revenue Cycle Operations

Coordinate day-to-day revenue cycle operations under the direction of the Revenue Cycle Manager.
Monitor the complete revenue cycle from patient registration through final payment resolution.
Review patient registration, demographic, and insurance information to ensure billing accuracy.
Monitor daily claim submissions and clearing house reports to identify and resolve claim rejections promptly.
Review billing edits and work queues to ensure timely processing.
Track and monitor accounts receivable (A/R) aging reports and assist with reducing outstanding balances.
Perform follow-up activities with commercial insurance, Medicare, Medicaid, Managed Care Organizations, and other third-party payers.
Research unpaid, underpaid, denied, or delayed claims and coordinate corrective action.
Assist with appeals, reconsiderations, corrected claims, and payer correspondence.
Monitor payment posting accuracy and identify payment variances.
Identify billing trends and recommend workflow improvements.

Compliance and Quality Assurance

Ensure compliance with HIPAA, CMS regulations, payer guidelines, FQHC requirements, behavioral health billing regulations, and organizational policies.
Assist with internal and external billing audits.
Maintain documentation supporting billing compliance.
Assist in monitoring coding accuracy and documentation requirements.
Identify compliance risks and report concerns to leadership.

Reporting and Analysis

Prepare routine reports on:
- Claims status
- Denials
- Accounts Receivable
- Payment trends
- Credentialing status
- Productivity metrics
Analyze reimbursement trends and identify opportunities for revenue improvement.
Assist with monthly financial reporting and revenue cycle metrics.
Monitor key performance indicators (KPIs) including:
- Clean claim rate
- Days in A/R
- Denial rate
- Net collection rate
- First-pass resolution rate

Collaboration

Work collaboratively with clinical departments, finance, scheduling, registration, providers, and leadership.
Educate staff regarding payer requirements, billing procedures, and documentation standards.
Assist with onboarding and cross-training of revenue cycle staff as assigned.
Participate in departmental meetings and quality improvement initiatives.
Provide excellent customer service to patients, providers, insurance companies, and external agencies.

Other Duties

Maintain confidentiality of protected health information.
Participate in organizational committees as assigned.
Assist with special projects.
Perform additional duties as assigned by leadership.

REQUIRED COMPETENCIES-KSAS

Knowledge

Medical billing and reimbursement processes
Revenue cycle operations
Medical terminology
CPT, HCPCS, ICD-10 coding fundamentals
Insurance verification procedures
Medicare and Medicaid regulations
Commercial payer requirements
Behavioral health billing
FQHC reimbursement methodologies
Credentialing and provider enrollment processes
HIPAA Privacy and Security Rules
Electronic Health Records (EHR)
Revenue cycle software and billing platforms

Skills

Excellent analytical abilities
Strong organizational skills
Effective written and verbal communication
Critical thinking
Problem-solving
Time management
Data analysis
Customer service
Report preparation
Computer proficiency (Microsoft Office Suite, Excel, Outlook)

Abilities

Prioritize multiple competing deadlines.
Maintain confidentiality.
Interpret payer policies and billing regulations.
Work independently with minimal supervision.
Collaborate effectively across departments.
Identify process improvement opportunities.
Maintain accuracy under pressure.
Adapt to changing healthcare regulations.

MINIMUM QUALIFICATIONS

Education: Associate degree in Healthcare Administration, Business Administration, Accounting, Finance, Health Information Management, or related field required.
Bachelor’s degree may substitute for experience.
Experience:
- Minimum of two (2) to three (3) years of progressively responsible experience in medical billing, healthcare revenue cycle, insurance claims, or healthcare finance.
- Working knowledge of Medicare, Medicaid, commercial insurance, and managed care billing.
- Experience using Electronic Health Records (HER) and medical billing systems.
- Proficiency with Microsoft Office, especially Excel.

PREFERRED QUALIFICATIONS

Bachelor’s degree in healthcare administration, Business Administration, Accounting, or related field.
Three (3) to five (5) years of healthcare revenue cycle experience.
Experience in behavioral health, Federally Qualified Health Centers (FQHCs), Certified Community Behavioral Health Clinics (CCBHCs), or hospital-based billing.
Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), Certified Healthcare Access Associate (CHAA), or other applicable certification.
Experience with provider credentialing software and CAQH.
Knowledge of Indiana Medicaid and behavioral health payer requirements.

SUPERVISORY

Reports To: Revenue Cycle Director
Supervise: This position does not have direct supervisory responsibilities. The Revenue Cycle Coordinator may provide functional guidance, training, mentoring, and workflow coordination for Revenue Cycle staff under the director of the Revenue Cycle Manager.

CORE COMPENTENCIES

Integrity
Customer Focus
Teamwork
Communication
Accountability
Continuous Improvement
Attention to Detail
Professionalism

PERFORMANCE EXPECTATIONS

Performance will be evaluated based on, but not limited to:

Accuracy of billing and claims processing.
Timeliness of claim submission.
Reduction in claim denials and rejections.
Timeliness of Accounts Receivable follow-up.
Credentialing completed within required timeframes.
Compliance with payer and regulatory requirements.
Achievement of departmental productivity standards.
Quality and accuracy of reports.
Responsiveness to internal departments.
Attendance and dependability.
Contribution to departmental process improvements.
Maintenance of confidentiality and HIPAA compliance.
Positive teamwork and customer service.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS

This position is primarily performed in a professional office environment.

The employee is regularly required to:

Sit for extended periods.
Use a computer, keyboard and telephone throughout the workday.
Perform repetitive hand and wrist movements.
Read printed materials and computer screens.
Communicate verbally and in writing.
Occasionally stand, walk, bend, reach, or lift office materials weighing up to 20 pounds.
Travel occasionally between Edgewater Health locations for meetings or operational support.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

WORKING CONDITIONS:

Standard business hours with occasional extended hours based on operational needs.
Fast-paced healthcare environment with multiple priorities and deadlines.
Frequent interaction with patients, providers, insurance companies, government agencies, and staff.
Exposure to confidential patient, employee, financial, and organizational information requiring strict adherence to HIPAA and confidentiality standards.
Must maintain professionalism while managing competing priorities and responding to changing payer regulations and organizational needs.
Participation in departmental meetings, organizational training, quality improvement initiatives, and continuing education is expected.

DISCLAIMER & OTHER DUTIES

This job description is intended to describe the general nature and level of work performed by employees assigned to this position. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications. The Revenue Cycle Coordinator may be required to perform other duties as assigned to support organizational goals and evolving operational needs. Edgewater Health reserves the right to modify or revise this job description at any time to meet organizational needs.

EDGEWATER HEALTH

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