Job Description

The Revenue Cycle Representative I & II (RCR I & RCR II) is a member of the internal back-end revenue cycle team responsible for the patient-facing and account-level financial functions that remain in-house and are not managed by UPNT’s outsourced Revenue Cycle Services (RCS) vendor (Veradigm). This role serves as the primary point of accountability for work queue oversight & resolution, revenue cycle pools/chats, legacy AR management, unapplied payment research, patient escalation calls, patient accounts receivable (A/R) follow-up, outsource collection agency payment posting and reconciliation, patient payment plan administration, refund management, and referral and prior authorization coordination. The RCR I ensures timely, accurate, and compliant handling of patient accounts to support the organization's cash flow, patient satisfaction, and regulatory compliance goals.

Essential Job Responsibilities:

RCR I:

• Monitor active payment plans for missed or late payments and initiate appropriate follow-up.

• Modify, extend, or default payment plans per policy and appropriate approval levels.

• Communicate plan terms, changes, and reminders to patients in a clear, compliant manner.

• Review, prioritize, and work assigned work queue items daily within established productivity and turnaround-time standards.

• Research root causes of account holds, edits, denials routed to internal queues, and credit balances and respond back to the Veradigm AR team member on next action steps.

• Document all work queue actions clearly and consistently in the practice management/EHR system.

• Escalate systemic or recurring work queue issues to the supervisor for trend analysis and process improvement.

• Maintain work queue aging within departmental benchmarks by proactively managing and updating items to prevent them from exceeding the 45-day aging threshold.

• Reconcile unapplied and unidentified patient payment reports on a regular cadence (e.g., weekly).

• Research payment source, remittance detail, and patient account history to determine correct application.

• Research and confirm Missing Charges are all accounted for the unapplied payment in question.

• Confirm upcoming visits to which the patient payment can move to

• Process account transfers or reapplication of misapplied payments in accordance with practice policy.

• Present account refunds when all criteria above have been satisfied.

• Coordinate with cash posting/lockbox functions to resolve payment identification discrepancies.

• Maintain documentation supporting all payment application decisions for audit purposes.

Additional Responsibilities for RCR II include:

• Receive and respond to escalated patient calls regarding billing disputes, statement concerns, or complaints transferred from front-line staff or the call center.

• Investigate account history, insurance adjudication, and prior communications to provide an accurate, complete resolution.

• Apply de-escalation and service-recovery techniques to resolve patient concerns professionally and empathetically.

• Document escalation details, resolution, and any follow-up commitments in the patient account record.

• Orphan Payment Phreesia Reconciliation.

• Identify and report patterns in escalations that may indicate upstream process or communication issues.

• Monitor and work Patient A/R aging reports greater than 90 days to reduce outstanding balances within target timeframes.

• Initiate outbound contact (calls, Phreesia notifications/statements, portal messages) to patients regarding balances due.

• Prepare accounts for next-level action (e.g., payment plan, pre-collection notice, or agency placement) per policy.

• Process adjustments, corrections, and account reconciliations within approved authority levels.

• Process refund requests for both insurances and patients utilizing the Credit Balance Management tool monthly after thorough account review.

• Evaluate accounts for financial assistance, hardship, or write-off eligibility per policy and refer accordingly.

• Other duties, as assigned

Work Experience:

• RCR I: 0–2 years of experience in medical billing, collections, patient access, or a related healthcare revenue cycle role.
• RCR II: Minimum 2 years of progressive revenue cycle experience, including patient A/R, collections, or payment plan administration.

Skills:

RCR I & II: 

• Working knowledge of healthcare billing, insurance terminology, EOB/remittance interpretation, and patient financial responsibility concepts.

• Proficiency with practice management/EHR systems, work queue tools, and Microsoft Office (Excel in particular).

• Strong verbal and written communication skills; ability to de-escalate difficult patient conversations with empathy and professionalism.

• Sound judgment in applying financial assistance, adjustment, and collection policies.

• Detail-oriented with strong organizational and time-management skills to manage competing priorities and deadlines.

• Understanding of HIPAA, CMS, and other applicable regulatory requirements governing patient billing and collections.

• Ability to work collaboratively with internal departments and external partners, including collection agencies and payers.

Physical Requirements:

RCR I & II

• Primarily performed in an office or remote/hybrid setting with extended periods of computer and phone use.

• Requires sitting for extended periods; occasional standing, walking, and light lifting (up to 15 lbs).

• Requires use of telephone/headset for extended call volumes, particularly for escalation handling.

• May require occasional flexibility in schedule to support month-end close or high-volume periods.

Education:

RCR I & RCR II:

• High school diploma or equivalent required.

• Associate degree or coursework in healthcare administration, business, or related field preferred.

Certifications:  (Preferred, Not Required)

• Certified Revenue Cycle Representative (CRCR) or equivalent industry certification.

• Certified Patient Account Representative (CPAR), Certified Professional Biller (CPB), or similar.

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