Revenue Cycle Specialist I

Change Lives With Recovery Innovations!

Our Mission is to empower people on their journey to recovery, helping them achieve their goals, rediscover meaning and purpose in life, and reconnect with themselves and their communities.

Our Vision is to revolutionize healthcare by pioneering innovative solutions that go beyond behavioral health, empowering people to thrive in the communities where they live, work, and play.

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!

• Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher to ensure claim(s) resolution, which includes scrubbing, submission, and posting when applicable.
• Use Microsoft Teams for daily communication and collaboration and utilize Microsoft Office products, primarily Excel.
• There is potential for this role to become permanent, based on performance and business needs.
• Billing and Account Management: Works in conjunction with other RCM staff to assure timely completion of billing functions. Responsible for managing and maintaining 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.
• Works in conjunction with other RCM staff to assure timely completion of billing functions.
• Responsible for managing and maintaining 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.
• Claims Review and Reconciliation: Review underpayments and overpayments, prepare spreadsheet and summarize findings; escalate as appropriate. 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.
• Review underpayments and overpayments, prepare spreadsheet and summarize findings; escalate as appropriate.
• 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.
• Reporting and Communication: 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. Maintain tracking sheet of pending/resolved issues and historical payer issues. Schedule and attend departmental meetings/conference calls.
• 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.
• Maintain tracking sheet of pending/resolved issues and historical payer issues.
• 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.
• 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.
• Additional Duties: Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies. Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies and procedures as they presently exist and as they change or are modified. Performs other related duties as assigned.
• Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies and procedures as they presently exist and as they change or are modified.
• Performs other related duties as assigned.
• Education: High school diploma or equivalent .
• 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.
• 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.
• 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.
• Miscellaneous Requirements: Must be at least 18 years old unless residing in a state where funder or government regulations set a different minimum age requirement. Travel required based on business need. Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism. Must have a valid driver license. We are a Second-Chance Employer Must be able to pass a seven-year background check. Must be able to pass substance abuse testing and/or tuberculous testing (if applicable). Must be able to obtain designated fingerprinting clearance in applicable states. Must be able to pass education verification check. Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).
• Must be at least 18 years old unless residing in a state where funder or government regulations set a different minimum age requirement.
• Travel required based on business need.
• Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
• Must have a valid driver license.
• We are a Second-Chance Employer Must be able to pass a seven-year background check. Must be able to pass substance abuse testing and/or tuberculous testing (if applicable). Must be able to obtain designated fingerprinting clearance in applicable states. Must be able to pass education verification check. Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).
• Must be able to pass a seven-year background check.
• Must be able to pass substance abuse testing and/or tuberculous testing (if applicable).
• Must be able to obtain designated fingerprinting clearance in applicable states.
• Must be able to pass education verification check.
• Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).
• If driving is required for this position, must meet all requirements outlined in Recovery Innovations driving policy.
• If not qualified to drive per driving policy, a Non-Driver Attestation form must be signed.