Revenue Cycle Specialist I

Job Summary

Join a groundbreaking team at the forefront of Peer-Powered Support, empowering individuals on their journey through mental health and substance use challenges! Be part of something bigger—together, we can change lives and create lasting hope!

Duties / Responsibilities

• Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher to ensure claim(s) resolution.
• Use Microsoft Teams for daily communication and collaboration and utilize Microsoft Office products, primarily Excel.
• Manage and maintain a workload of approximately seventy (70) accounts or higher to ensure claim(s) resolution.
• Review outstanding claims to determine necessary action.
• Make status calls to insurance companies.
• Request claims to be reprocessed when necessary and prepare/submit corrected claims or appeals to the insurance companies for payment.
• Adjust claims that are deemed non-reimbursable.
• Monitor payer project work queues for both pending and submitted claims; move claims between work queues while documenting.
• Post contractual allowances based on fee schedule or expected payment/denial amounts per third party contracts.
• Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.
• Call payers to determine the true reason for denial and inquire on what corrections need to be made.
• Investigate receipt of claims and payer portals to maximize reimbursement.
• Create and distribute specific reports to staff such as the account detail report, unbilled report and any other claims detail report for proper follow-up as needed.
• Prepare and submit denied claims targeted project files to payers, track reprocessing of project files.
• Provide feedback to both department and payers on project status.
• Schedule and attend departmental meetings/conference calls.
• Coding, Compliance, and Documentation:
• Knowledge of CPT, HCPCS, and ICD-10 codes.
• Identify problematic claim trends and contract violations and report findings to the Manager and Director.
• Follow company processes related to submission of corrected claims and appeals.
• Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.

Essential Duties and Responsibilities

• Billing and Account Management:
• Works in conjunction with other RCM staff to assure timely completion of billing functions.
• Coding, Compliance, and Documentation:
• Knowledge of CPT, HCPCS, and ICD-10 codes.
• Identify problematic claim trends and contract violations and report findings to the Manager and Director.
• Follow company processes related to submission of corrected claims and appeals.
• Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.

Job Requirements

• Education: High school diploma or equivalent.
• Experience: 2 years of medical (preferably Behavioral Health) billing and/or A/R experience.
• Preferable experience in either Arizona, North Carolina, Ohio and/or Washington markets.
• Working knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Demonstrated computer skills.
• Skills: Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
• Intermediate to Advanced proficiency in Microsoft Excel.
• Must have excellent written and verbal communication, with particular emphasis during telephone calls, follow-ups, and in-person correspondence.
• Prior training experience is preferred.
• Above average computer skills including databases, spreadsheets, interface file maintenance and related computer programs designed for billing, coding, and accounting purposes.
• Ability to focus on the big picture while attending to multiple detail requirements in a changing environment.
• Ability to analyze and interpret data.
• Ability to formulate, recommend and implement solutions.
• Ability to adapt to change in the workplace and demonstrate the ability to work collectively within a diverse team environment.
• Ability to use critical thinking and reasoning skills to solve a problem.
• Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas.
• Ability to find a solution for or to deal proactively with work-related problems.

Physical Demands

• May include work close to the eyes and substantial motions of the wrist, hands, and/or fingers.
• Frequent sitting, standing, walking, handling, finger dexterity; eye-hand-foot coordination, use of corrected vision; color vision; use of auditory senses.
• May be required to lift up to twenty (20) pounds.
• Work Environment May work in an office environment or behavioral health facility. May have contact with individuals who are agitated and/or confused. Work may include travel throughout the geographic region.

Benefits

As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and generous paid time off to support work-life balance. In addition, we provide ongoing opportunities for professional development and training to help you advance in your career. We value the contributions of our team members and are dedicated to fostering a supportive, inclusive environment where you can thrive both personally and professionally.