Revenue Cycle & Authorizations Specialist - Podiatry Clinic

Position OverviewWe are seeking a detail-oriented, high-performing Revenue Cycle & Authorizations Specialist to manage patient eligibility, obtain prior authorizations, and drive accounts receivable (AR) recovery.This role manages a core volume of approximately 200 claims per week, with a primary focus on navigating and resolving complex claim denials, prior authorization hurdles, and payer issues associated with two major HMO plans. The ideal candidate thrives on problem-solving, possesses strong payer navigation skills, and excels at keeping practice revenues steady and predictable.RequirementsPrimary ResponsibilitiesAccounts Receivable & Denials Management Manage end-to-end follow-ups on unpaid, underpaid, and denied claims across accounts receivable (AR) aging reports. Serve as the dedicated specialist for two high-priority HMO plans—actively researching rejection reasons, resubmitting corrected claims, filing appeals, and escalating administrative roadblocks. Process routine Medicare and PPO denials swiftly to ensure low aging across simpler payer types. Process, track, and reconcile approximately 200 claims per week. Authorizations & Insurance Verification Perform insurance eligibility and coverage verifications prior to patient appointments. Submit, track, and secure prior authorizations from commercial and managed care payers to prevent coverage gaps and claim rejections. Maintain clear communication with clinical staff regarding authorization statuses, limitations, and approval updates. Payer & Patient Communication Place high-volume follow-up calls to HMO representatives, medical groups, and clearinghouses to clear claim holds. Communicate politely and clearly with patients regarding insurance coverage rules, outstanding balances, or required authorization steps. Qualifications & Key Requirements Experience: 2+ years of experience in medical billing, accounts receivable management, and insurance prior authorizations. HMO Expertise: Strong working knowledge of HMO medical group referrals, capitation/FFS structures, and HMO-specific appeal pathways. Coding & Billing Knowledge: Working knowledge of CPT, ICD-10, HCPCS codes, modifiers, and CMS-1500 claim formats. Volume Capability: Proven ability to manage a consistent workload of ~200 claims per week without sacrificing accuracy. Reliability: High level of punctuality and commitment to maintaining the established 38-hour weekly work schedule. Originally posted on Himalayas