Mendry    ·    Florida 501(c)(3) Nonprofit    ·    Veteran-Built & Independent

Hub 03 · Billing and Revenue Cycle

4 Roles · 12 Sub Positions

Billing & Revenue Cycle

The financial engine of every practice.

Billing and revenue cycle professionals convert clinical care into clean claims and clean payments. They navigate Optum, TriWest, TRICARE, and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) reimbursement workflows. They work denials, manage Accounts Receivable (A/R), post payments, and keep the financial side of veteran-aligned practices running. When the work is done well, claims pay in fourteen days and no one notices. When it isn’t, practices lose tens of thousands of dollars in revenue every quarter.

HFMA

Revenue-cycle credentials

AAPC

Professional billing credentials

NHA

Billing & coding certification

State Payer Rules

State-specific reimbursement

Hub 01 · Overview

What Billing & Revenue Cycle Actually Does.

The Two-Hat Reality

Two-hat practices carry two billing realities under one roof. The revenue cycle professional is who keeps both sides paid cleanly and on time, so neither hat quietly drains the other.

4 Roles. 12 Positions

Billing & Revenue Roles in Detail.

Each primary role and the subroles that branch from it. Tap a role to drop down its subroles — careers here deepen in a role, then broaden across its subroles.

01

Medical Billing Specialist

A Medical Billing Specialist converts clinical care into clean claims and follows those claims through to payment. The work begins after the provider documents the visit and continues until the practice receives payment from every responsible party. Clean billing pays in fourteen days and nobody notices. Bad billing

02

Medical Coding Specialist (Billing Side)

A Medical Coding Specialist on the billing side assigns CPT, ICD-10, and HCPCS codes to clinical documentation so claims can be submitted accurately. This role overlaps with the Medical Coding subspecialty but focuses specifically on the billing-side work — coding for clean claim submission and reimbursement integrity. The

03

Charge Entry Specialist

A Charge Entry Specialist posts the coded charges to patient accounts so claims can be generated and submitted. The work sits at the critical junction between coding and billing — coders assign the codes, charge entry posts those codes accurately to the right patient accounts with the right

04

Claims Processor

A Claims Processor manages the claim submission workflow from the practice’s billing system through clearinghouses to payers. The work spans claim generation, scrubbing, submission, acceptance verification, and rejection management. Where billing specialists handle the full revenue cycle, claims processors focus specifically on the submission-to-acceptance window — making sure

05

Claims Analyst

A Claims Analyst examines claim-level data to identify patterns, recover under-payments, and prevent recurring revenue cycle issues. Where Claims Processors handle daily submission and rejection workflow, Claims Analysts work the analytical layer — finding the patterns in claim data that point to fixable problems and the under-payments that

06

Denial Management Specialist

A Denial Management Specialist works denied claims through the appeal and resubmission process to recover revenue that would otherwise be written off. The work begins where claim submission ends — every denied claim represents revenue that the practice has earned but not yet received. Strong denial management specialists

07

Accounts Receivable (AR) Specialist

An Accounts Receivable Specialist manages the unpaid balance on every patient account — following up on aged claims, coordinating patient collections, and ensuring no recoverable revenue ages out of collectability. The work runs on aging buckets — 0-30 days, 31-60 days, 61-90 days, 91-120 days, 121+ days. Each

08

Payment Posting Specialist

A Payment Posting Specialist applies payments and adjustments from EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice) to patient accounts in the practice management system. The work sits at the income side of revenue cycle — every dollar the practice receives flows through payment posting. Errors here

09

Revenue Cycle Analyst

A Revenue Cycle Analyst examines the entire revenue cycle as a system — from patient registration through final payment — identifying performance issues, modeling improvement scenarios, and providing the analytical foundation for practice leadership decisions. Where Claims Analysts focus on the claim level, Revenue Cycle Analysts focus on

010

Reimbursement Specialist

A Reimbursement Specialist analyzes payer contracts and ensures the practice receives the reimbursement it has contractually negotiated. The work bridges payer contracts and actual paid claims — comparing what the contract says payers should pay against what they actually pay, identifying under-payments, and pursuing recovery. The work is

011

EOB Analyst

An EOB Analyst examines EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice) for patterns that point to under-payments, payer behavior issues, and process improvement opportunities. The work is data-driven analysis focused specifically on the payment side of revenue cycle. EOB Analysts find the under-payments hidden in routine

012

Fee Schedule Analyst

A Fee Schedule Analyst manages the practice’s charge master and analyzes payer fee schedules to ensure the practice charges appropriately for services and receives appropriate reimbursement. The work is technical. The work is contract-driven. And it is the role that determines whether the practice’s charges align with payer

01

Medical Billing Specialist

A Medical Billing Specialist converts clinical care into clean claims and follows those claims through to payment. The work begins after the provider documents the visit and continues until the practice receives payment from every responsible party. Clean billing pays in fourteen days and nobody notices. Bad billing

02

Medical Coding Specialist (Billing Side)

A Medical Coding Specialist on the billing side assigns CPT, ICD-10, and HCPCS codes to clinical documentation so claims can be submitted accurately. This role overlaps with the Medical Coding subspecialty but focuses specifically on the billing-side work — coding for clean claim submission and reimbursement integrity. The

03

Charge Entry Specialist

A Charge Entry Specialist posts the coded charges to patient accounts so claims can be generated and submitted. The work sits at the critical junction between coding and billing — coders assign the codes, charge entry posts those codes accurately to the right patient accounts with the right

04

Claims Processor

A Claims Processor manages the claim submission workflow from the practice’s billing system through clearinghouses to payers. The work spans claim generation, scrubbing, submission, acceptance verification, and rejection management. Where billing specialists handle the full revenue cycle, claims processors focus specifically on the submission-to-acceptance window — making sure

05

Claims Analyst

A Claims Analyst examines claim-level data to identify patterns, recover under-payments, and prevent recurring revenue cycle issues. Where Claims Processors handle daily submission and rejection workflow, Claims Analysts work the analytical layer — finding the patterns in claim data that point to fixable problems and the under-payments that

06

Denial Management Specialist

A Denial Management Specialist works denied claims through the appeal and resubmission process to recover revenue that would otherwise be written off. The work begins where claim submission ends — every denied claim represents revenue that the practice has earned but not yet received. Strong denial management specialists

07

Accounts Receivable (AR) Specialist

An Accounts Receivable Specialist manages the unpaid balance on every patient account — following up on aged claims, coordinating patient collections, and ensuring no recoverable revenue ages out of collectability. The work runs on aging buckets — 0-30 days, 31-60 days, 61-90 days, 91-120 days, 121+ days. Each

08

Payment Posting Specialist

A Payment Posting Specialist applies payments and adjustments from EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice) to patient accounts in the practice management system. The work sits at the income side of revenue cycle — every dollar the practice receives flows through payment posting. Errors here

09

Revenue Cycle Analyst

A Revenue Cycle Analyst examines the entire revenue cycle as a system — from patient registration through final payment — identifying performance issues, modeling improvement scenarios, and providing the analytical foundation for practice leadership decisions. Where Claims Analysts focus on the claim level, Revenue Cycle Analysts focus on

010

Reimbursement Specialist

A Reimbursement Specialist analyzes payer contracts and ensures the practice receives the reimbursement it has contractually negotiated. The work bridges payer contracts and actual paid claims — comparing what the contract says payers should pay against what they actually pay, identifying under-payments, and pursuing recovery. The work is

011

EOB Analyst

An EOB Analyst examines EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice) for patterns that point to under-payments, payer behavior issues, and process improvement opportunities. The work is data-driven analysis focused specifically on the payment side of revenue cycle. EOB Analysts find the under-payments hidden in routine

012

Fee Schedule Analyst

A Fee Schedule Analyst manages the practice’s charge master and analyzes payer fee schedules to ensure the practice charges appropriately for services and receives appropriate reimbursement. The work is technical. The work is contract-driven. And it is the role that determines whether the practice’s charges align with payer

01

Provider Enrollment Specialist

A Provider Enrollment Specialist onboards credentialed providers into payer networks — submitting enrollment applications, tracking each application through review, and confirming the provider’s active status before billing begins. Where the Credentialing Specialist verifies the provider’s credentials, the Enrollment Specialist takes those verified credentials and gets them accepted into

02

Provider Enrollment Coordinator

A Provider Enrollment Coordinator manages enrollment workflow across multiple providers, multiple payers, and often multiple practices simultaneously — tracking every active enrollment application, coordinating with the Specialists who submit them, and reporting pipeline status to practice leadership. The work is operational. The work is pipeline-focused. And it is

03

Provider Data Specialist

A Provider Data Specialist maintains the accuracy of provider information across every directory, every payer database, and every public-facing listing where the practice’s providers appear. The work is increasingly critical as the No Surprises Act and CMS provider directory requirements impose accuracy mandates with real financial penalties. Bad

04

Provider Relations Representative

A Provider Relations Representative serves as the bridge between practices and the payer networks they participate in — handling escalations, resolving claim disputes, communicating policy changes, and building the relationships that keep practices working productively with each payer. The work is communication-heavy. The work is relationship-driven. And it

05

Provider Network Coordinator

A Provider Network Coordinator builds and maintains the geographic and specialty composition of a payer’s provider network — analyzing network adequacy, identifying gaps in coverage, recruiting providers to fill gaps, and ensuring the network meets state and federal access standards. The work is strategic. The work is analytical.

06

Payer Enrollment Specialist

A Payer Enrollment Specialist handles enrollment across multiple payers simultaneously — VA CCN, TRICARE, CHAMPVA, Medicare, Medicaid, commercial payers — coordinating the parallel application processes that get a provider active in every network the practice participates with. Where the Provider Enrollment Specialist focuses on the application work for

07

CAQH Profile Manager

A CAQH Profile Manager maintains the CAQH ProView profiles that serve as the single source of credentialing truth for hundreds of payers across the United States. The Council for Affordable Quality Healthcare (CAQH) operates the universal credentialing database that practically every commercial payer and many federal payers use

08

Primary Source Verification (PSV) Specialist

A Primary Source Verification (PSV) Specialist verifies provider credentials directly from issuing authorities — state medical boards, certifying boards, educational institutions, training programs, malpractice carriers, and DEA. NCQA standards require primary source verification for credentialing files because copies, scans, and self-reported information are not sufficient to establish credential

09

State Medicaid Enrollment Specialist

A State Medicaid Enrollment Specialist navigates state-specific Medicaid programs and the Managed Care Organizations (MCOs) that administer most state Medicaid networks. Each state runs Medicaid differently. Each state contracts with different MCOs. Each MCO has its own enrollment process. The work is state-specific, complex, and increasingly essential as

Credentials That Support This Work

The Bodies and Certifications Behind the Role.

These are the professional bodies and certifications relevant to this specialty, listed for reference. Mendry is a membership organization — it does not issue these credentials, require them for membership, or verify that any member holds them.

Healthcare Financial Management Association (HFMA)

Revenue-cycle credentials

AAPC

Professional billing credentials

American Medical Billing Association (AMBA)

Certified Medical Reimbursement Specialist

National Healthcareer Association (NHA)

Billing & coding certification

Glossary

Every Acronym Used on This Page.

Defined in full on first use above and collected here as the reference backstop.

A/R

Accounts Receivable — money owed to a practice for services already delivered.

NHA

National Healthcareer Association.

EOB

Explanation of Benefits — the statement a payer issues describing what was covered on a claim.

CHAMPVA

Civilian Health and Medical Program of the Department of Veterans Affairs — a health benefits program for families of certain veterans.

HFMA

Healthcare Financial Management Association.

AAPC

AAPC — a medical coding and billing certifying body (program name; no longer spelled out).

TRICARE

The U.S. Department of Defense health program for service members, retirees, and their families.

AMBA

American Medical Billing Association.

VA

U.S. Department of Veterans Affairs — the federal department serving veterans.

Find Your Specialty. Find Your People.

Mendry does not employ, place, refer, or supervise Direct Care Support Professionals. We list independent members so the two-hat practices that need them can find them. Your business, your reputation, your decisions.