Revenue Cycle Specialist

This is a fully remote position, open to applicants in Arizona, +4 more states.

📋 Description

• Oversee assigned accounts receivable (A/R) by consistently following up via payer portals, phone calls, and CentralReach Claim Accelerator to ensure timely resolution and payment of claims.

• Investigate and address claim statuses, denials, rejections, underpayments, overpayments, recoupments, and payment discrepancies, including reviewing Explanation of Benefits (EOBs)/Electronic Remittance Advice (ERAs) and payer adjudications.

• Submit corrected claims, reconsiderations, appeals, and any necessary supporting documentation, including medical records, while adhering to HIPAA and confidentiality standards.

• Identify and report billing errors, recurring issues with payers, and trends in claims to the Revenue Cycle Management (RCM) Manager and the billing team.

• Assist with payer audits, insurance refunds, adjustments, and recoupments, ensuring that all required documentation and approvals are completed promptly.

• Investigate and resolve issues related to timesheets and claims, including approved IT corrections and transaction adjustments.

• Maintain precise and thorough A/R notes and claim documentation in CentralReach, including payer contacts, follow-up actions, statuses, and resolutions.

• Keep track of timely filing deadlines and payer-specific requirements, including updates to billing, authorization, coding, and reimbursement guidelines.

• Aid in A/R cleanup, payer research, denial reduction, process enhancement, and other RCM projects as directed by the RCM Manager.

• Provide professional and prompt assistance to providers and internal departments regarding billing and insurance inquiries, escalating issues as necessary.

• Perform additional RCM-related tasks as assigned.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare medical billing and/or accounts receivable (A/R) is required.

• Strong comprehension of the healthcare revenue cycle, including claim submissions, payer adjudications, denials, appeals, payment postings, and A/R follow-ups.

• Proven experience in researching claims and identifying the root causes of billing and payment issues.

• Experience in medical billing and medical coding is essential.

• Preferred knowledge of ABA billing and behavioral health revenue cycle processes.

• Preferred familiarity with billing practices related to Speech-Language Pathology and Occupational Therapy.

• Preferred knowledge of ABA CPT codes and specific billing requirements from payers.

• Experience dealing with Commercial, Medi-Cal/Medicaid, and managed care payers is preferred.

• Familiarity with payers in California, Arizona, Colorado, Texas, Virginia, and Washington is an advantage.

• Strong preference for candidates with experience using CentralReach (CR).

• Experience with electronic payer portals and clearinghouses is preferred.

• An associate degree and/or medical billing/coding certification such as AHIMA or AAPC is preferred.

• Strong analytical and problem-solving skills with the capacity to research complex claim issues and determine suitable next steps.

• Exceptional attention to detail and a high level of accuracy is required.

• Excellent written and verbal communication skills.

• Ability to communicate professionally with insurance representatives, providers, families, and internal departments.

• Capacity to manage multiple priorities and meet deadlines in a fast-paced environment.

• A strong sense of urgency and ownership of assigned A/R is essential.

• Highly organized, reliable, and self-driven.

• Ability to work independently while also effectively collaborating as part of a team.

• Comfortable with quickly learning new systems, processes, and payer requirements.

• Strong customer service skills and a professional, solution-oriented mindset.

• Candidates must reside in California, Arizona, Texas, Washington, or Colorado.

• Candidates must have legal authorization to work in the United States.

• Candidates must be willing to work regular Pacific Standard Time (PST) hours.

🏝️ Benefits

• Competitive pay that is industry-benchmarked based on location and experience.

• Paid time off.

• Medical, Vision, and Dental coverage through Anthem Insurance; 80% coverage for employees and 50% for dependents.

• Life, Accidental Death & Dismemberment, Accident, Hospital Indemnity, Short Term Disability, and Critical Illness Insurance.

• Invest in your mental well-being with access to free mental health sessions.

• Protect your pet with discounted pet insurance.

• Secure your future through our 401k program.

• Tuition discounts available to all employees through our University Partnerships.

• Expansive treatment spaces.

• Opportunities for roles in a variety of settings: clinic or in-home.

• A scheduling department that manages reschedules, cancellations, and permanent changes to schedules.

• Necessary work tools provided.

• Company-sponsored fun events for all employees.