Revenue Cycle Specialist II

Copa Health•Mesa, AZ

9d•$21

About The Position

Under the direct supervision of the Revenue Cycle Supervisor, the Revenue Cycle Specialist II position is responsible for identifying and resolving complex claims issues adversely impacting the revenue cycle management process and achieve resolution through coordination, reconciliation and denied claim management. The primary responsibility of the Revenue Cycle Specialist II is to ensure proper follow-up is performed on the back-end aspects of the revenue cycle process related to reimbursement, including projects, problem and issues escalation, A/R management and research. The Revenue Cycle Specialist II should possess a thorough understanding of payor guidelines and policies and be able to evaluate the effect of such changes in our internal workflows. Additionally, follow internal and external policies and procedures and ensure proper revenue is booked by monitoring payments, fee schedule changes, Health plan reimbursement changes and other aspects that impact revenue, cash collections and adjustments.

Requirements

High school diploma or General Equivalency Diploma (GED); or equivalency of education and years of experience are acceptable
Minimum four (4) years medical accounts receivable experience required.
Ability to obtain and maintain Level One fingerprint clearance and meet agency personnel requirements

Nice To Haves

College or certification course work, preferred
Behavioral health billing experience preferred.

Responsibilities

Perform full revenue cycle billing and collections functions.
Review and analyze Explanation of Benefits (EOBs), remittance advice, and payment posting entries.
Verify claim status with payers through phone, payer portals, and other communication channels.
Contact insurance carriers and third-party payers to verify claim receipt, secure payment timelines, and resolve discrepancies.
Research and resolve claims that have been underpaid, denied, or delayed.
Monitor billing and electronic charge entry processes to ensure compliance with departmental accounts receivable standards.
Identify and escalate trends or issues affecting payer reimbursement or claim processing.
Conduct follow-up on aged accounts receivable balances (30, 60, 90, and 120+ days).
Investigate delayed payments and resolve barriers to reimbursement.
Review accounts to confirm contractual compliance and payment accuracy.
Manage worklists and reports related to unpaid, underpaid, or denied claims.
Reconcile claims submissions with payer payments and denials.
Investigate and resolve claim denials and payment reductions.
Submit corrected claims and prepare first-level appeals for technical denials.
Work denied claims within established timelines (typically within 30 days of receipt).
Track denial trends and assist with reporting for revenue cycle leadership.
Post insurance payments, denials, and adjustments accurately and timely.
Research and resolve payer credit balances when applicable.
Ensure payments align with payer contracts and fee schedules.
Collaborate with Revenue Cycle leadership, credentialing teams, and program staff to resolve billing issues.
Assist in identifying payer policy changes and evaluate potential impacts on internal workflows.
Maintain productivity and quality standards established by the Revenue Cycle Leadership Team.
Complete all required organizational and departmental training within required timelines.
Perform other duties as assigned.

Benefits

Limitless Growth and Career Advancement Opportunities: Thrive with us through diverse career paths and internal development programs.
Career Development: Access ongoing training and development through our dedicated Organizational Development & Learning Department.
Generous PTO Program: Enjoy up to 3 weeks off in your first year, with continuous accruals and an additional PTO day for Employee Well-Being.
Paid Holidays: Celebrate 10 paid holidays annually.
Wellness Program: Benefit from our expert Health Coach services and wellness incentives to reduce costs.
Tuition Reimbursement: Receive up to $3,000 for educational advancement.
Affordable Health Care Plans: Choose from comprehensive Medical, Vision, and Dental plans.
Flexible Spending Accounts: Utilize H.S.A., H.R.A, and F.S.A. options with select medical plans.
Insurance Coverage: Enjoy free Short-Term Disability, Long-Term Disability, and Life/AD&D Insurance up to $100,000.
Retirement Savings: Benefit from 403(b) retirement plans with a company match.
Employee Assistance: Access 6 free coaching and 6 free therapy sessions, plus a wealth of wellness content and services.
Additional Insurance Options: Aetna Medical, Delta Dental, Eyemed vision, Pet Insurance, Additional Life/AD&D Insurance, and more!