Specialist III: Revenue Cycle Operations

Department: Patient Financial Services
Status: Full-Time | 1.0 FTE (40 hours/week)
FLSA Status: Non-Exempt
Reports To: Director: Revenue Cycle
Location: Pagosa Springs Medical Center – Pagosa Springs, Colorado
Work Arrangement: On-Site Required

🏥 Position Highlight

Bring your revenue cycle expertise to a dynamic, cross-functional role where you'll help keep patient financial operations moving, solve complex account and reimbursement issues, improve workflows, and support teams across the entire revenue cycle.

Position Summary

Pagosa Springs Medical Center (PSMC) is seeking an experienced and versatile Specialist III: Revenue Cycle Operations to join our Patient Financial Services team.

This full-time, on-site position supports multiple Revenue Cycle functions to help ensure patient financial workflows are efficient, accurate, and compliant. The Specialist III serves as a flexible operational resource, providing departmental coverage, process improvement, reporting, training support, and assistance with special projects. The position also provides leadership to Revenue Cycle staff in the absence of managers and the Director.

This is an excellent opportunity for an experienced revenue cycle professional who understands how the pieces of the revenue cycle fit together and enjoys solving problems, supporting coworkers, improving processes, and stepping into different areas based on operational needs.

Why Join PSMC?

• Work across multiple areas of the healthcare revenue cycle rather than being limited to a single function
• Use your experience to solve complex billing, reimbursement, authorization, and account issues
• Serve as an operational resource for Patient Access, Financial Counseling, HIM, Billing, Claims, Payment Posting, Denial Management, and Customer Service
• Help identify and implement workflow improvements that increase efficiency and support cash collections
• Develop your leadership skills by providing guidance and support to Revenue Cycle staff
• Work closely with Revenue Cycle leadership, clinical teams, providers, coding staff, and payers
• Make a meaningful impact on both PSMC's financial performance and the patient financial experience

Key Responsibilities

Revenue Cycle Operations

• Support Revenue Cycle departments including Patient Access, Financial Counseling, HIM, Billing, Claims, Payment Posting, Denial Management, and Customer Service
• Perform assigned revenue cycle functions based on operational needs and workload priorities
• Provide coverage for vacancies, PTO, leaves of absence, and fluctuations in departmental volume
• Coordinate daily revenue cycle activities including patient registration, scheduling, insurance verification, authorizations, charge capture, billing, collections, and payment posting
• Assist with account resolution, claim follow-up, payment research, and work queue management
• Cross-train throughout Revenue Cycle to effectively provide operational support where needed

Billing, Claims & Account Resolution

• Monitor accounts receivable work queues and ensure timely follow-up on unpaid, denied, and underpaid claims
• Investigate and resolve claim edits, denials, and reimbursement discrepancies
• Verify insurance coverage, benefits, and authorization requirements to support clean claim submission
• Ensure accurate and timely claim submission in accordance with payer guidelines and regulatory requirements
• Reconcile payments, adjustments, and contractual allowances to ensure account accuracy
• Maintain accurate documentation of account activity, follow-up actions, and correspondence
• Collaborate with providers, clinical staff, coding teams, and payers to resolve billing and reimbursement issues

Prior Authorizations & Patient Financial Support

• Monitor scheduling and prior authorizations to help ensure patients are scheduled promptly and efficiently
• Verify insurance benefits and authorization requirements
• Assist with patient account inquiries
• Provide billing support to patients and their families
• Help resolve financial and insurance-related issues while providing professional, patient-centered service

Reporting & Process Improvement

• Monitor key Revenue Cycle performance indicators and identify opportunities for improvement
• Support month-end reporting, revenue reconciliation, and operational audits
• Assist in developing and implementing workflow improvements that enhance efficiency and cash collections
• Participate in quality assurance initiatives
• Support special projects related to Revenue Cycle optimization
• Use analytical and problem-solving skills to identify issues and recommend practical solutions

Training & Team Support

• Train and support staff on Revenue Cycle procedures, payer updates, and system changes
• Serve as a knowledgeable operational resource for Revenue Cycle staff
• Collaborate with leadership and team members to maintain productivity and meet departmental priorities
• Provide leadership to Revenue Cycle staff in the absence of managers and the Director
• Promote a collaborative environment focused on learning, quality, accountability, and continuous improvement

Compliance & Quality

• Ensure compliance with HIPAA, Medicare, Medicaid, commercial payer requirements, and organizational policies
• Support quality improvement activities to maintain departmental standards
• Maintain strict confidentiality of patient and financial information
• Help ensure Revenue Cycle processes remain accurate, timely, compliant, and patient-focused