Revenue Cycle Specialist

Job Summary:

Research and follow up on billing and payment Denials, Helds and other irregularities in a Behavioral Health Setting

Duties/Responsibilities:

• Ongoing process improvement analysis: and implementation of system improvements. Includes all activities within the scope of the Billing & Accounting Departments including charge/ data entry, insurance follow up, and billing and collection of client balances.
• Adheres to Billing and Accounting regulations, company policy, HIPPA, 42CFR, CMS, DHCS, DPH/SAPC, DMH guidelines and statutes and contract requirements.
• Assist in identifying, analyzing and addressing challenges and / or breakdowns in the revenue cycle process.
• Perform ongoing trend analysis of payer rejections and denials. Assist in performing proactive audits on all recommended A/R write offs.
• Collaborate closely with other departments to contribute to cash reconciliation activities and to assist in the assessment of accounts receivable collectability and validation, including the writing off of bad debts.
• Assist with the review of contracted rates and reimbursements.
• Assist in the creation and development of reports to address management needs; analyze information to identify trends or issues.
• Work in multiple EHR systems

Qualifications

Required Education:
- Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field. Equivalent experience may be considered in lieu of a degree.

Required Experience:
- Minimum of 3 years of experience in revenue cycle management within a healthcare setting, preferably in behavioral health services.
- Proven track record in managing billing, collections, and accounts receivable processes.
- Experience with healthcare insurance claims processing and knowledge of payer requirements.
- Familiarity with electronic health records (EHR) systems and healthcare billing software.

Required Skills and Abilities:
- Strong analytical skills with the ability to interpret financial data and generate actionable insights.
- Excellent communication skills, both written and verbal, with the ability to interact effectively with internal teams and external stakeholders.
- Detail-oriented with strong organizational skills to manage multiple tasks and priorities efficiently.
- Proficiency in Microsoft Office Suite, particularly Excel, for data analysis and reporting.
- Ability to work independently as well as collaboratively in a team-oriented environment.
- Knowledge of healthcare regulations and compliance standards, including HIPAA.
- Problem-solving skills with a proactive approach to identifying and resolving issues in the revenue cycle process.