Job Description

Job Description

Job Description

POSITION SUMMARY:

The Revenue Cycle Specialist is responsible for the full-cycle medical billing process, including eligibility verification, claims generation, eligibility verification, payment posting, denial resolution and follow-up, and responding to billing inquiries. While each Specialist may have a primary focus area (such as front-end processes like eligibility and claim creation or back-end processes like denials and follow-up), both roles are expected to be cross-trained and capable of performing all core billing functions to ensure operational coverage and flexibility.

Primary Responsibilities:

Billing, Claims Processing, and Compliance

• Verify insurance eligibility and hospice benefit coverage at admission and throughout care.

• Reconcile charges and coding in the EMR and billing system to ensure accuracy and compliance.

• Prepare, review, and submit Notices of Election (NOE) and Notices of Termination/Revocation (NOTR) in alignment with CMS timelines.

• Submit timely, accurate claims to Medicare, Medicaid, commercial, and self-pay accounts.

• Reconcile nursing home, GIP, and Respite invoices to ensure accurate vendor payments and billing.

Payment Posting, Denial Management Reconciliation

• Post Electronic Remittance Advices (ERAs) and manual payments in the billing system.

• Maintain the remittance folder and reconcile posted payments with bank deposits and payer documentation.

• Identify and follow up on underpayments, overpayments, and discrepancies; initiate appropriate corrective actions.

• Review and resolve rejected or denied claims through correction, resubmission, or appeal.

• Prepare and submit write-off requests to the Business & Revenue Cycle Manager, including supporting documentation and rationale.

• Maintain accurate billing records for compliance with Medicare and Medicaid regulations.

Billing Support and Communication

• Respond to internal questions regarding eligibility, payer coverage, and patient accounts.

• Address occasional patient inquiries regarding billing or statements, focusing on clarity and empathy in hospice care contexts.

• Collaborate with vendors and facilities (e.g., nursing homes) to reconcile room and board charges and ensure accurate third-party billing.

• Generate aging reports, denial reports, and reconciliation summaries. Other reports as needed.

• Support internal and external audits with timely documentation and claims history

Credentialing & Other Duties

• Assist in enrolling new providers with payers and maintaining active status.

• Maintain provider access in systems such as Hoku and PECOS to support accurate billing.

• Assist in creating and updating internal billing process documentation.

• Participate in team meetings to share insights, updates, and process improvements.

• Perform other billing-related duties as assigned.

Qualifications and Skill Requirements:

• Excellent communication and interpersonal skills

• Attention to detail and organizational skills.

• Ability to work harmoniously with a broad range of staff, volunteers, and the community as a representative of Navian Hawaii.

• Demonstrates good judgment in seeking and accepting guidance, facilitates clear and honest communication with other team members.

• Consistently demonstrates ethical conduct and judgment that is in harmony with the mission and values of Navian Hawaii

Experience and Educational Requirements:

• High School Diploma or GED equivalent required.

• 1–3 years of experience in healthcare billing and coding preferred; hospice specific billing is a plus.

• Experience in nonprofit healthcare setting is a plus.

• Proficient in the use of MS Word, Excel, Outlook, and overall computer skills. GL software knowledge preferred.

• Is knowledgeable of and maintains HIPAA standards of privacy and confidentiality.

Working Conditions:

• Indoors in an air-conditioned office / work from home

Equipment Used:

• Operates phone system, computer (Word, Excel, Microsoft Outlook, EMR Platform, clearinghouse, Bill.com, Cyma Accounting Software and other platforms accordingly), calculator, copier, and facsimile.

Hours:

• Generally, Monday through Friday, 8:00am through 4:30pm.

Why Navian Hawaii?

• Team-oriented, locally run nonprofit where every voice is heard
• Competitive pay with an excellent benefits package
• Flexible organization that supports positive work/life balance

Salary Range:

• $21-$27 per hour

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