Specialist, Medical Revenue Cycle Management

Pacific Dental Services Supported Office
Henderson, Nevada, United States, 89074
Oct 08, 2019
Nov 01, 2019
Contract Type
Job Type
Full Time

Specialist, Medical Revenue Cycle Management


Job ID: 2019-15335
Type: full-time
# of Openings: 1
Category: Operations
13000 - Nevada Region



The primary purpose and function of the Specialist, Medical Revenue Cycle Management is to reconcile and process medical claims for PDS medical practices. The Specialist will be responsible for credentialing, contract negotiations, billing, medical coding, claims submission, payment posting, accounts receivable, and account auditing and reconciliations. The Specialist will develop processes and procedures that ensure the most effective coding, billing and collections are completed. The incumbent will partner with the Revenue Operations Center (ROC) and be proactive in their efforts to ensure insurance companies are billed correctly and promptly.



  1. Perform daily activities of coding, billing and auditing.
  2. Research CPT and ICD-10-CM coding discrepancies for compliance and reimbursement accuracy.
  3. Obtain patient information including diagnosis or ICD-10-CM (International Classification of Disease Systems) codes to enter appropriate billing as necessary.
  4. Answer inquiries from staff and/or clients concerning CPT codes.
  5. Prepare and perform written reports of all audits.
  6. Read and analyze Explanation of Benefits (EOB) statements and adjust accounts according to PDS claims processing criteria, including; claim tracing, and contacting insurance carriers and/or ensuring patients balances are secures as appropriate.
  7. Ensure effective and accurate charge entry, fix of claims editing reports, processing claims, A/R follow-up, payment posting and researching/auditing of accounts.
  8. Establish and maintain effective working relationships with the physicians and medical practices to effectively address and resolve charge flow issues and any related billing adversities.
  9. Develop systematic approach for process improvement, and effectively coordinate and communicate changes and enhancements.
  10. Ensure compliance with Company policies, as well as State, Federal and other regulatory bodies.
  11. Other duties as assigned by management.




  • Bachelor’s Degree in Health Information Administration, Medical Coding, or related field from an accredited college or technical school. In lieu of degree, 6+ years of professional experience is required.
  • Experience with at least one of the following: medical billing, credentialing, payment posting, account reconciliations, or accounts receivables.
  • Coding course work in medical terminology, anatomy, and physiology.


  • Certified Professional Coder (CPC).
  • Certified in ICD-10-CM, CPT, and HCPCS coding.
  • Knowledge of WORD, EXCEL, POWERPOINT, NextGen and QSI software applications
  • Good understanding of how to read and interpret EOBs (Explanation of Benefits).
  • Previous experience in Medical/Dental/healthcare/Retail industry is preferred.

Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.


Apply Here: http://www.Click2Apply.net/hff9xdjy5qdzgfxv