Job Summary
The Revenue Cycle Coordinator ("Coordinator") serves as the primary coordinator responsible for maintaining the accuracy, integrity, and synchronization of provider, payer, facility, enrollment, and billing-related information across KIC revenue cycle systems. The Coordinator ensures information is accurately established, maintained, and synchronized across multiple revenue cycle, practice management, clinical, payer, and enrollment systems to support successful claims processing, reimbursement, revenue integrity, and revenue cycle operations.
This position investigates, analyzes, and resolves system, enrollment, and data integrity issues that impact billing readiness, claim submission, reimbursement, and revenue recovery. The Coordinator works closely with Revenue Cycle leadership, Patient Access, clinical departments, Human Resources, Finance, providers, and external payers to ensure data is maintained accurately, system changes are coordinated effectively, and revenue cycle risks are identified and addressed proactively.
This position requires exceptional attention to detail, strong organizational and tracking skills critical thinking, sound judgment, discretion in handling confidential information, and the ability to independently manage complex responsibilities across multiple systems and stakeholders.
Job Duties & Responsibilities
- Maintain provider, payer, facility, location, taxonomy, eligibility, enrollment, and billing information across multiple revenue cycle, clinical, practice management, payer, and other organizational systems.
- Coordinate updates across interconnected systems to ensure information remains accurate, consistent, and billing ready.
- Validate, reconcile, and maintain data received from internal departments, providers, payers, and external entities.
- Coordinate provider, facility, and organizational enrollment, revalidation, maintenance, and related activities with Medicare, Medicaid, VA, commercial payers, and other third-party payers.
- Maintain enrollment records, payer portals, CAQH profiles, credentialing-related data, and supporting documentation required for enrollment and reimbursement activities.
- Monitor enrollment status, effective dates, renewals, terminations, demographic updates, and other changes impacting billing and reimbursement.
- Investigate and resolve data discrepancies, enrollment issues, payer issues, claim holds, billing concerns, denials, and reimbursement issues related to provider, payer, demographic, taxonomy, location, or system data, including issues identified through revenue cycle operations, reimbursement monitoring, or escalation from Revenue Cycle leadership.
- Research root causes of system and data integrity issues, coordinate corrective action, and implement updates necessary to prevent recurrence and reduce future reimbursement, billing, and data integrity risks.
- Identify and communicate system, enrollment, configuration, or data issues that may affect claims processing, reimbursement, compliance, or revenue capture.
- Research enrollment, billing, reimbursement, and payer requirements for new providers, programs, services, locations, and organizational initiatives to support implementation and billing readiness.
- Maintain enrollment trackers, status reports, supporting documentation, and electronic records in an organized and audit-ready manner.
- Serve as a liaison among Revenue Cycle, Patient Access, Human Resources, Finance, Credentialing, clinical leadership, providers, payers, and other stakeholders to gather, validate, communicate, and maintain information necessary for billing readiness and reimbursement.
- Ensure activities are conducted in accordance with payer requirements, HIPAA, KIC policies, and applicable regulatory standards.
- Serve as an organizational resource regarding provider enrollment, payer participation, system data management, and billing readiness.
- Perform other related duties as assigned.
Necessary Knowledge, Skills, and Abilities
- Exceptional attention to detail and accuracy, especially when managing, validating, maintaining, and reconciling data across multiple systems.
- Strong organizational, tracking, documentation, and follow-through skills.
- Ability to understand the relationship between provider enrollment, payer participation, system configuration, claims processing, reimbursement, and revenue cycle performance.
- Ability to maintain, reconcile, analyze, and update information across multiple interconnected systems while understanding downstream impacts to billing, claims processing, and reimbursement.
- Ability to analyze, investigate, and resolve data discrepancies, enrollment issues, payer issues, reimbursement issues, and other revenue cycle-related concerns.
- Ability to identify root causes of data integrity, enrollment, reimbursement, and system-related issues and implement appropriate corrective actions.
- Ability to interpret and apply payer enrollment requirements, reimbursement requirements, provider participation requirements, and related healthcare administrative processes.
- Ability to conduct research and gather information necessary to support provider enrollment, payer participation, billing readiness, reimbursement, and implementation of new programs or services.
- Ability to exercise sound judgment and discretion when handling highly confidential provider, patient, payer, tribal eligibility, credentialing, enrollment, and organizational information.
- Strong understanding and sensitivity to American Indian/Alaska Native (AI/AN) Tribal culture and lifestyle, working effectively with AI/AN populations.
- Effective oral and written communication skills with sensitivity to the lifestyles of targeted participants.
- Skills in operating personal computers using a variety of computer software.
- Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.
- Ability to maintain strict confidentiality and comply with applicable federal and tribal privacy laws and KIC policy (HIPAA, HITECH, etc.).
- Ability to learn and apply program/agency operating policies and procedures.
- Ability to manage multiple priorities and tasks concurrently and meet deadlines.
- Ability to work independently as well as with teams.
Working Conditions
The physical demands described here are representative of those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit, climb, or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and depth perception. The noise level in the work environment is usually average.
KIC Core Competencies
Cultural Competency: To be respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of KIC Tribal Members. Developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum.
Uphold KIC Values: To make decisions and behave in a manner consistent with KIC Workplace Values of Trust, Teamwork, Respect, and Accountability, as well as Southeast Traditional Tribal Values “Our Way of Life”.
Commitment: To serve Tribal Members and set a high standard for yourself in your performance; strive for results and success; convey a sense of urgency and bring issues to closure; and stay persistent despite obstacles and opposition.
Customer Service: Meet/exceed the expectations and requirements of internal and external customers; identify, understand, and monitor the needs of both internal and external customers; always talk and act with customers in mind; and recognize working colleagues as customers.
Effective Communication: Ensure important information is passed to those who need to know; convey necessary information with respect, clearly and effectively orally or in writing.
Responsiveness and Accountability: Demonstrate a high level of conscientiousness; hold oneself personally responsible for one's own work; and do the required fair share of work.
Qualifications
Minimum Qualifications (Education & Experience)
- High school diploma or equivalent required.
- Three (3) years of experience in healthcare administration, provider enrollment, revenue cycle, insurance, credentialing, payer relations, healthcare billing, or related healthcare operations.
- A combination of relevant experience, education, and training may substitute for education and experience requirements on a year-for-year basis.
- Proof of valid driver's license with acceptable driving record
Preferred Qualifications (Education & Experience)
- Associate degree in healthcare administration, business, health information management, or related field.
- Five (5) years of progressively responsible healthcare revenue cycle, enrollment, credentialing, or healthcare systems experience.
- Experience working with multiple EHR, billing, payer, or practice management systems.
- Experience working with Medicare, Medicaid, VA, commercial insurers, or healthcare payer portals.
- Experience in community clinic preferred and a strong commitment to multi-disciplinary teamwork.
Conditions of Hire
- May be required to possess and maintain a valid driver's license or capable of obtaining one, as well as be insurable by KIC’s company insurance.
- KIC is a Drug-Free Workplace. All employees must adhere to KIC drug and alcohol policies and procedures to ensure a safe workplace. Employees must pass a pre-employment and subsequent random and/or for-cause drug and alcohol screening to be eligible for and maintain employment.
- KIC has several positions that must comply with the P.L. 101-630 Indian Child Protection and Family Violence Protection Act (ICPA); all employment offers in the "covered" classification are conditional until KIC has received a federal criminal background check verifying eligibility to work in these programs.
