Revenue Cycle Collections Specialist

Behavioral Innovations•Plano, TX

6d•Onsite

About The Position

The Revenue Cycle Collections Specialist ensures accurate and timely adjudication of third-party claims submitted to insurance carriers. The role supports increased cash collections and reduced aging in third-party accounts receivable by following up on outstanding claims and patient account balances. Work includes addressing denials and zero payments, submitting corrected claims and medical records, locating missing payments, initiating appeals, correcting posting errors, processing adjustments and write-offs, resolving credit balances, using payer and clearinghouse portals, and managing payer correspondence. The specialist communicates with Commercial, Medicaid, and Managed Care payers and RCM leadership, conducts detailed research, and applies payer guidelines, company policies, and third-party collection best practices. This is an onsite role at the company’s corporate office in West Plano, Texas. It may become eligible for a hybrid schedule based on individual performance. The position reports to the Revenue Cycle Management Manager.

Requirements

At least five years of experience in the healthcare industry.
At least five years of experience in medical revenue cycle collections.
Strong attention to detail and commitment to high-quality work.
Excellent judgment and decision-making skills.
Clear and effective communication abilities.
Proactive approach to identifying and resolving issues.
Eagerness to learn and take on new responsibilities.
Resourcefulness, collaboration, and teamwork.
Consistently uphold and reflect the organization’s core values in professional interactions.
Must currently reside in the Dallas–Fort Worth area.
Must work onsite at the corporate office in Plano, Texas.

Nice To Haves

At least five years of experience in a behavioral health or medical clinic setting; preferred but not required.

Responsibilities

Analyze and evaluate claim payments using internal systems and tools to ensure provider reimbursement aligns with applicable state fee schedules.
Review payer documentation and contact insurance carriers by phone to confirm receipt of claims and facilitate reimbursement.
Investigate and resolve third-party payer claim issues, including claim adjustments and resubmissions according to payer-specific guidelines.
Follow up on submitted claims to ensure timely payment and escalate unresolved issues to payers, internal departments, or RCM leadership as needed.
Evaluate payment and denial accuracy, apply payments to patient accounts, and identify bad debt write-offs and accounts receivable adjustments according to company policy.
Detect and resolve duplicate or overpayments and process necessary corrections.
Communicate with internal departments to gather missing patient or insurance information.
Comply with HIPAA regulations and applicable federal, state, and payer guidelines.
Verify billing accounts against the accounts receivable ledger to confirm accurate payment posting.
Document interactions in the EHR, including call details, contact information, and outcomes.
Address denial issues within three days of receipt.
Submit medical records and documentation for medical necessity reviews, denials, and appeals in a timely manner.
Submit secondary claims promptly after receiving the primary remit.
Reduce third-party accounts receivable and improve days sales outstanding.
Use electronic medical records and billing systems efficiently.
Collaborate with team members, leadership, and other departments using strong interpersonal and communication skills.
Support workflows across departments and perform other duties as assigned.