Revenue Cycle Specialist (53481)

Westcare•Henderson, NV

18d•Onsite

About The Position

The Revenue Cycle Specialist supports the full revenue lifecycle, including claim preparation and submission, accounts receivable follow-up, payment posting, denial management, and coordination of payer authorizations and credentialing. The role helps ensure accurate, timely reimbursement while maintaining compliance with payer requirements, Medicaid, managed care organizations (MCOs), commercial payer guidelines, and organizational policies. The position also supports facility and provider credentialing across multiple states by assisting with payer enrollment, tracking documentation, and ensuring billing readiness for new and existing programs. The specialist works closely with clinical and administrative teams and the director of revenue cycle to resolve billing and credentialing issues, verify benefits, obtain authorizations, and support revenue cycle operations. Work is primarily performed in an office setting. The role involves occasional lifting of more than 10 pounds, as well as sitting, standing, walking, and reaching. The normal work routine involves no exposure to blood, body fluids, or tissues, although exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be available for employees engaged in Category II tasks.

Requirements

High school diploma or equivalent required.
At least 2 years of experience in medical billing, accounts receivable, credentialing, or revenue cycle operations.
Ability to pass criminal and Medicaid background clearance as required.
Ability to obtain CPR and First Aid certification and complete annual tuberculosis testing as required.
Compliance with applicable organizational, state, and federal requirements, including vaccination or testing requirements when mandated.
Ability to work collaboratively with others in a pleasant and professional manner.
Experience with electronic medical records, billing systems, and clearinghouses.
Basic to intermediate understanding of insurance contracts, terminology, codes, and claim submission.
Attention to detail.
Ability to operate a computer and complete documents in Microsoft Word formats, or ability to learn.
Ability to complete work tasks within scheduled work hours.
Excellent verbal and written communication skills.

Nice To Haves

Billing and coding certification such as CPC, CCS, or equivalent.
Associate’s degree or higher in Healthcare Administration, Business Administration, Accounting, or a related field.
Experience with Medicaid, managed care organizations, and commercial insurance billing.
Experience with provider credentialing and payer enrollment processes.
Experience with behavioral health or substance use disorder billing.
Familiarity with authorization processes, utilization review, and level-of-care criteria such as ASAM.

Responsibilities

Prepare, review, and submit accurate and timely claims to Medicaid, managed care organizations, commercial insurers, and other payers.
Enter charges, review CPT, HCPCS, and ICD-10 coding, and ensure claims are properly set up before submission.
Post payments, adjustments, and denials from EOBs and ERAs in the billing system and reconcile them against internal tracking logs.
Follow up on outstanding accounts receivable and investigate unpaid, underpaid, or denied claims.
Analyze denials, identify root causes, and complete corrections, resubmissions, reconsiderations, and appeals as appropriate.
Communicate with insurers and payer representatives to verify benefits, check claim status, resolve discrepancies, and obtain payment.
Verify patient insurance eligibility, benefits, and authorization requirements for different levels of care.
Review clinical documentation and case notes for authorization requests and communicate with payers regarding medical necessity.
Coordinate with clinical staff and internal departments to ensure services are documented, authorized, and billable.
Assist with monthly close activities, including reconciliation of payments, open claims, and revenue reporting.
Identify and communicate billing, authorization, credentialing, or claim-processing issues that may affect reimbursement.
Assist with payer audits, documentation requests, and compliance reviews.
Collaborate with revenue cycle leadership to improve processes, reduce denials, and increase collection efficiency.
Assist with provider and facility credentialing and re-credentialing for Medicaid, MCOs, and commercial payers across multiple states.
Prepare, collect, and maintain credentialing documentation, including licenses, certifications, malpractice insurance, W-9s, and other required materials.
Support provider enrollment in CAQH, NPI/NPPES, PECOS where applicable, and state Medicaid portals.
Track credentialing application status, follow up with payers, and escalate delays or issues that affect billing readiness.
Ensure providers and facilities are enrolled, linked, and active with payers before claims are submitted.
Identify credentialing gaps or errors that may result in claim denials or non-par payment status and communicate them to leadership.
Maintain credentialing logs and ensure provider information is current, accurate, and compliant with payer and regulatory requirements.
Assist with payer communications concerning credentialing, contracting, and enrollment updates.
Coordinate with internal teams on new program or location launches to ensure credentialing and payer setup are completed timely.
Maintain organized and accessible credentialing documentation to support audit readiness.