Revenue Cycle Operations Specialist (Full-time; On-site required) at Pagosa Springs Medical Center in Pagosa Springs Medical Center - PAGOSA SPRINGS, CO 81147

Job description

• Salary Range
• $24.75 - $38.27 Hourly
• Position Type
• Full Time
• Job Shift
• Day
• 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
• 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.
• 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.
• 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
• Has broad healthcare Revenue Cycle knowledge and enjoys working across multiple functional areas
• Understands the relationship between registration, insurance verification, authorization, coding, billing, claims, payments, denials, and collections
• Is comfortable jumping into different areas based on departmental priorities and workload
• Enjoys investigating complicated accounts and finding solutions
• Is analytical, highly organized, and attentive to detail
• Can effectively prioritize competing responsibilities in a fast-paced environment
• Communicates professionally with patients, coworkers, providers, payers, and leadership
• Enjoys helping others learn and is comfortable serving as a resource to Revenue Cycle staff
• Demonstrates initiative and can work independently without losing sight of team priorities
• Embraces continuous improvement and looks for better, more efficient ways to accomplish work
• Embodies PSMC's WISER values of Wholeness, Integrity, Stewardship, Excellence, and Respect

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

Requirements

• Education
• High school diploma or equivalent required
• Associate's degree in Healthcare Administration, Business Administration, Finance, or a related field preferred but not required
• Experience
• Minimum of three (3) years of healthcare revenue cycle experience required
• Experience across multiple Revenue Cycle functions strongly desired
• Hospital, physician practice, or healthcare system Revenue Cycle experience strongly desired
• Electronic health record experience, particularly Cerner, strongly desired
• Knowledge & Skills
• Strong knowledge of CPT-4/HCPCS coding required
• Knowledge of healthcare Revenue Cycle processes and reimbursement methodologies
• Understanding of insurance verification, prior authorizations, billing, claims management, payment posting, and denial resolution
• Strong analytical and problem-solving skills
• Strong organizational and time-management abilities
• Ability to adapt quickly to changing priorities and departmental needs
• Excellent written and verbal communication skills
• Ability to work independently and collaboratively
• Strong working knowledge of Microsoft Office applications, particularly Excel, Outlook, Word, and Teams, as well as Access, data entry, and spreadsheets
• Current AHA BLS (HeartSaver) certification required

Skills

Required

• CPT-4/HCPCS coding
• Electronic health record (Cerner)

Benefits

• Base Compensation Range: $24.75 - $38.27 hourly, based on 0-22 years of relevant experience. "Relevant experience" means relevant to the employee's responsibilities set forth in the job description as determined by the HR Manager, CAO, applicable department manager/director and applicable senior leader.
• Benefits: Benefits include generous paid time off, separate sick leave, health, dental, vision, life and AD&D insurance, long-term disability and option for short-term disability, and retirement plan with employer contribution.
• Job Type: Full-time
• Anticipated End Date for Posting: September 20, 2026. The deadline may close sooner due to an unanticipated business necessity, such as an incumbent vacating the role earlier than anticipated. You are encouraged to apply well in advance of the deadline.
• Pagosa Springs Medical Center is an Equal Opportunity Employer. All qualified applicants will be considered for employment, and we will not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, marital status, or any other characteristic protected by law. Offers of employment are contingent upon successful completion of a pre-employment health and drug screen and background check.