The Revenue Cycle Specialist is responsible for researching and resolving payment and account discrepancies to ensure the accuracy and integrity of patient accounts. Working primarily within Athenahealth, this role performs detailed account analysis, payment research, worklist resolution, refund processing, and payment reconciliation activities. The Specialist collaborates with internal teams, vendors, and payers to resolve complex account issues while maintaining established quality,

productivity, and compliance standards.

This position requires strong analytical skills, attention to detail, and the ability to navigate multiple systems while supporting the overall goals of the Revenue Cycle department.

Essential Functions and Responsibilities

• Research and resolve payment discrepancies and account variances to ensure accurate account balances and payment application.
• Work assigned Athenahealth worklists, reviewing patient accounts and determining appropriate resolution based on payment, adjustment, and account activity.
• Investigate unapplied, misapplied, unidentified, and unallocated payments and take corrective action when appropriate.
• Review and process patient and insurance refunds in accordance with departmental policies and regulatory requirements.
• Verify deposits and reconcile payment activity utilizing bank portals, payer portals, internal reporting, and supporting systems.
• Retrieve remittance information and supporting documentation necessary to complete payment research and account resolution.
• Utilize Athenahealth as the primary workflow platform while leveraging additional systems and reporting tools, including Tableau and LK Oasis, to support account analysis and research.
• Monitor and respond to departmental communications, including shared mailboxes within established service level expectations.

• Identify recurring payment or account issues and communicate trends, workflow barriers, and improvement opportunities to leadership.
• Collaborate with internal Revenue Cycle departments, vendors, payers, and other stakeholders to resolve account-related issues.
• Support audits, special projects, process improvement initiatives, and cross-functional departmental activities as assigned.
• Maintain established productivity, quality, and accuracy standards.
• Adhere to HIPAA regulations, company policies, and confidentiality requirements while safeguarding Protected Health Information (PHI).

Required Qualifications

• High School Diploma, GED, or equivalent required.
• Minimum one (1) year of experience in healthcare revenue cycle, medical billing, payment posting, payment reconciliation, refunds, banking, accounting, collections, or a related field.
• Strong analytical and problem-solving skills.
• Ability to interpret payment activity, identify discrepancies, and determine appropriate resolution.
• Proficiency with Microsoft Office applications, including Excel and Outlook.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to prioritize workload, manage multiple assignments, and meet deadlines.
• Ability to work independently while contributing to a collaborative team environment.
• Demonstrated commitment to quality, accuracy, and continuous improvement.

Preferred Qualifications

• Experience working within Athenahealth.

• Experience managing payment-related worklists and account resolution activities.
• Knowledge of patient and insurance refund processes.
• Banking, cash application, reconciliation, or payment research experience.
• Familiarity with payer portals, remittance processing, and healthcare reimbursement workflows.

Core Competencies Technical Competencies

• Patient Account Resolution
• Payment Research & Reconciliation
• Refund Processing
• Worklist Management
• Revenue Cycle Operations
• Data Analysis
• Athenahealth
• Microsoft Excel

Professional Competencies

• Attention to Detail
• Accountability
• Analytical Thinking
• Problem Solving
• Communication
• Collaboration
• Adaptability
• Time Management
• Quality Focus