Description

POSITION SUMMARY              

The Revenue Cycle Operations Coordinator supports day-to-day revenue cycle activities, including provider enrollment, payer maintenance, medical records coordination, and revenue integrity tasks. This role takes ownership of maintaining accurate payer data, resolving issues as they arise, supporting audits, and helping ensure revenue cycle processes run smoothly and in compliance with payer and company requirements. Reports directly to the Vice President, Revenue Operations.

JOB SPECIFIC EXPECTATIONS

Provider Enrollment & Payer Operations

• Independently coordinate ongoing provider and group enrollment maintenance, including CAQH updates, attestations, and payer demographic changes.
• Maintain and monitor payer portals, ensuring accuracy of provider, banking, and participation data across payers.
• Review, triage, and process payer correspondence and mail, identifying action items and coordinating follow-up with internal stakeholders.
• Support and respond to Medicaid and commercial payer audits, including documentation preparation, variance identification, and issue resolution.
• Perform provider group audits (e.g., Verity), analyzing payer alignment and initiating corrective actions as needed.
• Conduct EFT and virtual credit card (VCC) payment audits, identifying discrepancies, recommending resolutions, and escalating issues when appropriate.

Payor Strategy & Rate Maintenance

• Coordinate maintenance of contracted payer rates within the corporate master rate file.
• Validate rate accuracy against executed agreements and escalate discrepancies for review.
• Support payer strategy initiatives by maintaining clean, reliable rate and participation data.

Revenue Cycle & Medical Records Coordination

• Oversee chart flow tracking within Arietis, identifying bottlenecks and coordinating resolution to support timely billing.
• Coordinate provider schedule and reconciliation activities related to GCA and records management.
• Manage secure file transfers via FTP, ensuring compliance with HIPAA and company data security standards.
• Maintain and update operations master files, exercising judgment to ensure data integrity across revenue cycle workflows.
• Perform records reconciliation, evaluating completeness and resolving discrepancies.
• Coordinate scanning and indexing of medical records received in the ATL office to ensure timely system availability.
• Monitor and independently respond to inquiries received via [email protected], determining appropriate resolution paths.

Requirements

MINIMUM JOB REQUIREMENTS       

Education & Qualifications:

Education: High School Diploma with Associate’s or Bachelor’s degree preferred; equivalent healthcare revenue cycle experience considered.

Licensure & Certifications: N/A

Previous Experience: Two years plus (2+ ) years of experience in revenue cycle operations, provider enrollment, payer maintenance, or medical records coordination required in a healthcare setting.

Skills: Working knowledge of CAQH, payer portals, EFT/VCC payments, and healthcare data management systems, with strong analytical, organizational, and problem-solving skills. Highly organized, detail-oriented, and self-driven, able to manage multiple workflows independently, meet strict deadlines, and perform well in a fast-paced, high-volume healthcare environment. Effective written and verbal communicator with excellent customer service skills, capable of engaging internal teams, providers, payers, and external partners while maintaining a high level of confidentiality. Maintains accurate physician and practitioner credentialing and payer enrollment records across multiple states and builds productive relationships with payer representatives, providers, and billing and contracting partners to support timely enrollment, issue resolution, and protect revenue integrity.

Computer Skills: The credentialing department works in a mostly paper-free environment. Previous experience with provider credentialing/enrollment software (i.e. VerityStream) necessary.  Expertise in Microsoft Office (Excel and Word). Proficiency with standard business software (Microsoft Windows, and PowerPoint) and using a laptop and mobile device is required.