Job Title: Specialty Hospital Revenue Cycle Liaison
Work Location: Oklahoma City, OK
Division/Department: Pafford Medical Billing Services
Reports To: Ambulance Coding Supervisor
FLSA Status / Type: Full-Time / Nonexempt

The Specialty Hospital Revenue Cycle Liaison is responsible for managing the complete revenue cycle for designated hospital specialty contracts. This role ensures accurate patient registration verification, insurance eligibility and benefits verification, medical coding, claims follow-up, and specialized hospital invoicing. This position serves as the primary liaison for assigned hospital contracts, ensuring timely reimbursement, accurate billing, and compliance with payer and contractual requirements.

Essential Duties and Responsibilities

• Verify patient demographics and insurance eligibility prior to services.
• Review and update patient registration information to ensure billing accuracy.
• Perform insurance verification, benefits investigation, and authorization review as required.
• Assign accurate ICD-10-CM, CPT, and HCPCS codes in accordance with coding guidelines and payer requirements.
• Review documentation to ensure coding accuracy and compliance.
• Submit and monitor claims for assigned hospital specialty contracts.
• Perform post-billing follow-up with insurance carriers regarding claim status, denials, appeals, and payment discrepancies.
• Research and resolve billing edits, denials, and underpayments.
• Prepare and submit specialty invoices to hospital clients according to contractual billing requirements.
• Reconcile payments and maintain accurate financial records for assigned accounts.
• Communicate with hospital representatives regarding account status, billing questions, and outstanding invoices.
• Maintain compliance with HIPAA, CMS regulations, payer policies, and organizational procedures.
• Generate reports and monitor key performance indicators related to revenue cycle performance.
• Assist with process improvement initiatives to maximize reimbursement and reduce claim turnaround time.
• Perform other duties as assigned.

Education and/or Work Experience

• High School Graduate or GED required
• Preferred EMT or Paramedic with a minimum of 2 years of field experience.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar certification preferred.
• Minimum of 2 years of experience in medical billing, coding, and revenue cycle management.
• Experience with hospital or specialty physician billing preferred.
• Knowledge of ICD-10-CM, CPT, HCPCS, and medical billing regulations.
• Familiarity with commercial, Medicare, and Medicaid insurance plans.
• Experience with electronic medical records (EMR) and practice management systems.
• Strong analytical, organizational, and problem-solving skills.
• Excellent communication and customer service skills.
• Ability to manage multiple specialty accounts while meeting deadlines with a high degree of accuracy.

Other Requirements

• Reliable access to high-speed internet
• This is a hybrid position. During the first six months, employees are required to work in the Oklahoma City (OKC) office at least three days per week. Based on training and business needs, in-office attendance may increase to as many as five days per week.

Physical Requirements

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• The employee may occasionally be required to lift and/or move up to 20 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion.
• Must be able to talk, listen and speak clearly on telephone.
• Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle.

Travel Time: Negligible

NOTE: The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills, and physical demands required of personnel so classified.