Billing & Revenue Cycle Specialist

West Texas Counseling & Guidance•San Angelo, TX

3d•Onsite

About The Position

The Billing & Revenue Cycle Specialist plays a key role in supporting the financial accuracy and integrity of the organization’s billing and revenue cycle operations. This position is responsible for processing medical claims, verifying insurance coverage, posting payments, managing account balances, and following up on unpaid, denied, or rejected claims to support timely reimbursement. The ideal candidate will demonstrate strong attention to detail, excellent organizational and follow-up skills, and the ability to research and resolve billing issues while managing multiple priorities. This position requires effective communication and problem-solving skills to work collaboratively with clients, clinicians, insurance representatives, and administrative staff. The Billing & Revenue Cycle Specialist reports directly to the QA & Billing Supervisor and is part of the billing team, which works closely with Intake, Quality Assurance, Finance, clinical staff, and leadership to support accurate and efficient billing and revenue cycle processes. Regular and timely attendance is required.

Requirements

High school diploma or equivalent required
Knowledge of insurance claims processing and medical billing practices.
Working knowledge of ICD-10 and HIPAA requirements.
Experience reviewing EOBs and ERAs and working with claim denials, rejections, corrected claims, appeals, and payment posting.
Proficiency with Microsoft Office and the ability to learn and utilize electronic health record, billing, payer, and other software systems.
Must successfully pass a comprehensive background check.
Strong attention to detail and accuracy in billing, data entry, and recordkeeping.
Excellent organizational and time-management skills with the ability to prioritize multiple responsibilities and meet deadlines.
Strong research, analytical, and problem-solving skills.
Excellent follow-through and accountability.
Effective written and verbal communication skills.
Ability to communicate clearly and professionally with clients, staff, providers, and insurance representatives.
Ability to work independently with minimal supervision and as part of a collaborative team.
Ability to maintain confidentiality and appropriately handle sensitive client and financial information.
Dependability and consistent attendance.
Ability to meet established productivity and accuracy expectations.
Willingness to learn and adapt to changing payer requirements, regulations, and organizational processes.

Nice To Haves

Associate’s degree in accounting, business, healthcare administration, or a related field preferred.
Two (2) or more years of medical billing, healthcare billing, collections, accounts receivable, or revenue cycle experience preferred.
Experience with insurance verification and benefits coordination preferred.
Experience with Medicaid, Medicare, and commercial insurance billing preferred.
Behavioral health or mental health billing experience preferred.
Texas Medicaid and/or New Mexico Medicaid billing experience preferred.
Medical billing or revenue cycle certification is a plus.

Responsibilities

Review accounts to ensure demographic, insurance, authorization, and billing information is accurate prior to claim submission.
Verify insurance eligibility, benefits, and authorization requirements as needed.
Submit medical claims accurately and timely to Medicaid, Medicare, commercial insurance companies, third-party payers, and other applicable programs.
Review claims for accuracy and monitor for rejections, denials, pended claims, and other processing issues.
Research claim rejections and denials and take appropriate action to correct and resubmit claims.
Submit corrected claims and appeals when appropriate.
Contact insurance companies and payer representatives to resolve unpaid, rejected, or improperly processed claims.
Review payer requirements and reimbursement guidelines to ensure claims are billed appropriately.
Identify recurring claim issues and communicate concerns to the appropriate staff or supervisor.
Monitor and work assigned accounts receivable to ensure outstanding balances are addressed timely.
Follow up on aging insurance and client accounts.
Research unpaid balances and determine the appropriate course of action.
Review account histories, claims, Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and payer correspondence to resolve outstanding issues.
Post client and insurance payments accurately and timely.
Apply contractual adjustments and other approved account adjustments appropriately.
Research and resolve payment discrepancies, unapplied credits, and incorrect payments.
Review accounts for outstanding balances, credits, and other discrepancies.
Assist with maintaining accurate accounts receivable balances and timely collection of revenue.
Identify billing and payment trends that may negatively impact the revenue cycle and communicate opportunities for process improvement.
Review client accounts for balances and billing information.
Prepare and process client statements.
Follow organizational procedures for contacting clients regarding outstanding balances.
Communicate professionally and respectfully with clients regarding billing questions, balances, payments, and refunds.
Assist with approved payment plans and collection arrangements when applicable.
Refer clients to available financial assistance or other resources when appropriate.
Maintain accurate documentation of client billing communications and account activity.
Collaborate with Intake, Quality Assurance, clinicians, and administrative staff to ensure accurate billing and insurance information.
Communicate billing concerns to appropriate staff to help prevent future claim issues.
Work with providers and staff when documentation or additional information is needed to support billing.
Assist with resolving issues related to insurance eligibility, authorizations, referrals, and payer requirements.
Maintain professional communication with clients, insurance representatives, providers, and coworkers.
Participate in billing meetings, training, and process improvement initiatives.
Assist with special projects and perform other duties as needed.
Maintain strict confidentiality of client information and comply with HIPAA and organizational privacy requirements.
Follow payer requirements, organizational billing policies, and applicable federal and state regulations.
Maintain accurate and timely documentation of claim follow-up, account activity, and billing communications.
Ensure billing activity is properly documented within the organization’s electronic systems.
Protect client financial and health information at all times.