Position Summary:
Navian Hawaii is seeking a detail-oriented and experienced Revenue Cycle Specialist to manage the full-cycle medical billing process. This role includes eligibility verification, claims submission, payment posting, denial resolution, and communication with internal and external stakeholders. While team members may specialize in either front-end (eligibility, claims) or back-end (denials, payments) processes, all Specialists are expected to be cross-trained and capable of performing all core billing functions to ensure consistent operational coverage.
Key Responsibilities:
Billing & Claims Processing
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Verify insurance eligibility and hospice benefit coverage at admission and throughout the duration of care.
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Submit accurate, timely claims to Medicare, Medicaid, commercial insurance, and self-pay accounts.
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Reconcile EMR and billing data to ensure accuracy and compliance with CMS guidelines.
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Submit Notices of Election (NOE) and Notices of Termination/Revocation (NOTR) in alignment with federal timelines.
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Reconcile facility invoices (e.g., GIP, Respite, Nursing Home) for accurate vendor payment and billing.
Payment Posting & Denial Management
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Post ERAs and manual payments into the billing system; reconcile against deposits and payer records.
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Investigate underpayments, overpayments, and discrepancies; resolve or escalate as needed.
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Review and resolve rejected or denied claims through correction, resubmission, or appeals.
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Submit write-off requests with appropriate documentation to the Business & Revenue Cycle Manager.
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Maintain accurate billing records in compliance with Medicare and Medicaid regulations.
Administrative Support & Reporting
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Respond to internal questions related to patient eligibility, coverage, and account status.
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Handle occasional billing-related inquiries from patients with professionalism and empathy.
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Collaborate with third-party facilities for billing reconciliation.
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Generate and maintain aging reports, denial reports, and reconciliation summaries.
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Support internal and external audits with required billing documentation and history.
Credentialing & Operational Support
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Assist with payer credentialing and revalidation processes for new and existing providers.
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Maintain provider access and profiles in Hoku, PECOS, and other billing systems.
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Contribute to documentation of internal billing procedures and workflows.
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Participate in team meetings to provide updates and suggest process improvements.
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Perform other billing-related duties as assigned.
Qualifications:
Education & Experience
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High School Diploma or GED required.
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1–3 years of healthcare billing/coding experience preferred; hospice billing experience a plus.
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Experience in nonprofit healthcare or hospice settings is desirable.
Skills & Competencies
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Knowledge of billing procedures and coding (CPT, HCPCS, ICD).
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Proficiency in MS Office Suite, especially Excel and Outlook.
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Familiarity with EMR platforms, clearinghouses, Bill.com, and accounting software (e.g., CYMA) preferred.
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Strong attention to detail, organizational skills, and ability to work independently.
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Excellent written and verbal communication skills.
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Must maintain confidentiality and adhere to HIPAA regulations.
Work Environment:
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Remote work with standard office equipment.
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Indoor, air-conditioned setting.
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Flexible, team-oriented culture focused on collaboration and work-life balance.
Why Join Navian Hawaii?
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Mission-driven, locally run nonprofit where your work has a meaningful impact.
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Competitive compensation with a flexible work environment.
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Team-oriented culture that values collaboration, ethics, and integrity.
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Opportunity to grow and contribute to a respected organization serving the community.
To Apply:
Interested candidates should submit their resume and a brief cover letter outlining relevant experience.