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Job Summary / Objective:

The Revenue Success Advocate is responsible for ensuring timely and accurate reimbursement of claims by managing accounts receivable workflows, including claim follow-up, denial resolution, payment review, and account reconciliation. This role plays a critical part in maintaining the organization’s financial performance through proactive account management, collaboration with payors and internal stakeholders, and delivery of high-quality customer service to patients and clinic partners.

Key Responsibilities:

• Claim Follow-Up & Collections: Proactively contact insurance payers to obtain claim status updates, resolve discrepancies, and secure reimbursement on outstanding balances. Process claim corrections, resubmissions and account adjustments as needed.

• Denial Resolution: Investigate denied or underpaid claims by reviewing medical records, coding, and payer guidelines; take corrective action to ensure proper reimbursement.

• Appeals Management: Prepare, write, and submit detailed appeals for complex or escalated denials while ensuring compliance with payer requirements and regulations.

• Payment Verification: Review and validate insurance payments against contractual rates; identify and resolve underpayments or inaccuracies.

• Patient Account Management: Maintain accurate patient financial records, document all activity and follow-up actions, and ensure timely resolution of outstanding balances.

• Correspondence Review & Response: Review insurance and patient correspondence to determine appropriate action; respond to patient billing concerns and questions with clear, timely, and professional communication.

• Data & Trend Analysis: Review clearinghouse rejections, denial trends, and payment patterns; identify root causes and recommend process improvements.

• Cross-Functional Coordination: Collaborate with providers, clinical staff, and internal teams to obtain necessary documentation, referrals, and authorizations for claim resolution.

• Productivity and Quality: Meet established productivity, quality, and accuracy standards.

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Additional Duties & Skills:

• Perform payment posting, including accurate application of insurance and patient payments. • Provide patient and clinic customer service by addressing billing inquiries and resolving concerns promptly and professionally. • Conduct daily charge review to verify accuracy and completeness prior to claim submission. • Serve as backup support for charge entry and payment posting functions to ensure operational continuity. • Identify and support process improvement opportunities within revenue cycle workflows. • Participate in team initiatives and special projects as assigned.

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Required Skills & Abilities:

• Expertise in navigating and querying insurance payer portals and websites • Strong ability to read and interpret Explanation of Benefits (EOBs) • Proficiency in healthcare terminology and medical coding fundamentals (CPT, HCPCS, ICD) • Excellent time management and organizational skills with ability to manage high-volume workloads • Strong written and verbal communication skills • Ability to effectively communicate with patients, payors, and internal stakeholders • Competency in Microsoft Office 365, especially Excel • Strong attention to detail and problem-solving ability

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Education & Experience:

Required: • High school diploma or equivalent • Minimum of 2 years of experience in insurance payment posting and/or accounts receivable follow-up across multiple payors • Experience working in an Electronic Medical Record (EMR) system

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Preferred:

• Experience with denial management and appeals processes • Familiarity with payer contracts and reimbursement methodologies • Certification in medical billing or coding (e.g., CPC, CPB)