About This Role
This role focuses on researching and resolving billing and payment denials, holds, and other irregularities within a behavioral health setting. The specialist will contribute to process improvement and ensure adherence to various healthcare regulations.
Responsibilities
- Perform ongoing process improvement analysis and implement system improvements across billing and accounting activities, including charge/data entry, insurance follow-up, and client balance collection.
- Adhere to billing and accounting regulations, company policy, HIPAA, 42CFR, CMS, DHCS, DPH/SAPC, DMH guidelines and statutes, and contract requirements.
- Assist in identifying, analyzing, and addressing challenges and 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.
- 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
Requirements
- Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field; equivalent experience may be considered in lieu of a degree.
- 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.
- 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.
