Revenue Cycle Specialist

LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS•Ardmore, OK

10d•$26 - $26•Onsite

About The Position

Lighthouse Behavioral Wellness Centers is seeking a Revenue Cycle Specialist to join their team. This role is crucial in navigating financial challenges within the healthcare system, guided by core values of hope, dedication, and community. The Revenue Cycle Specialist will be responsible for reviewing, adjusting, and collecting on claims and claim denials for Medicaid, Medicare, and private insurance payers. This involves ensuring claims are accurate and meet billing standards for submission. The position also requires assessing and monitoring trends, collaborating with the Revenue Cycle team to resolve issues, and establishing best practices and workflows to prevent future errors. Success in this role requires meeting expected performance standards, with Lighthouse providing necessary tools and training.

Requirements

High school diploma or its equivalent
Experience in the medical field, medical billing/claims, explanation of benefits, denials, or medical billing preferred.
Ability to develop working relationships with clinical staff and supervisors.
Must be a self-starter and able to work independently, as well, as in a team environment.
Must be very detail oriented and possess the ability to multi-task.
Proficient in utilizing Excel and Word.

Nice To Haves

Experience in the medical field, medical billing/claims, explanation of benefits, denials, or medical billing

Responsibilities

Participate in activities involved in the review, adjustment and collection of claims and claims denials for all Medicaid, Medicare, and Private Insurance payers.
Assist in taking all steps necessary to ensure that claims are correct and meet billing standards for submission.
Assess and monitor trends and work closely within the Revenue Cycle team environment to ensure resolution and establish best practices and workflows to prevent future errors.
Provide claim management for all payer claims.
Process ODMHSAS, Medicaid, Medicare, and private insurance claims in a timely manner.
Identify client account errors by utilizing error reports to prevent billing errors, denied claims, and missed filing.
Identify client account errors that prevent billing, such as missing CDC or client setup errors, and report to direct supervisor for correction.
Resolve payer rejections from the electronic health record (EHR) prior to billing submission.
Perform Medicare and private insurance corrections to claims and resubmit to payer.
Correct denied OHCA and ODMHSAS claims and resubmit through OHCA portal.
Appeal claims when appropriate according to payer rules.
Research payments and posts non-electronic EOB’s to accounts timely to accurately reflect monies received.
Review, work and document private insurance and Medicare coverage verification daily and report any discrepancies to direct supervisor for review.
Report error trends, claims denial trends, and contract billing issues to the Director of Revenue Cycle and Compliance weekly.
Assist Director of Revenue Cycle and Compliance, and Accounting with the reconciliation of accounts.
Review client accounts prior to appointment communicating CDC or prior authorization needs to clinic Navigators, Clinicians, and Leadership as needed.
Review Crisis accounts, both current admissions and recently discharged, to ensure accuracy in CDC or prior authorization to ensure claim submission success.
Verify ODMHSAS, Medicare, Medicaid, and private insurance coverage requirements and work to ensure that all services have the necessary approvals in place prior to bill generation.
Review and correct CDC and prior authorization errors prior to billing submission.
Act as liaison between Lighthouse and the ODMHSAS helpdesk to correct or backdate CDC’s.
Work OneDesk tickets to address CDC issues.
Review and analyze denied, rejected, or underpaid claims, identifying reasons for non-payment (e.g., coding errors, authorization issues, payer policy denials).
Work proactively to resolve denials by re-submitting corrected claims, initiating appeals, and collaborating with insurance providers for payment resolution.
Identify patterns in denials and report to Director of Revenue Cycle and Compliance in a timely manner.
Prepare and submit timely and accurate appeal documentation for claims that have been denied or underpaid, ensuring all required information is included (e.g., medical records, patient history, corrected codes).
Follow up on appeals to ensure timely resolution and to track the status of each claim.
Maintain detailed records of all denial and appeal activity, including correspondence with insurance payers and any necessary corrective actions.
Conduct regular audits and analysis of denied claims to identify trends or recurring issues.
Generate and present reports to management outlining denial rates, reasons for denials, and potential strategies to reduce future denials.
Adhere to Lighthouse policies and procedures.
Maintain regular and predictable attendance.
Complete Lighthouse required training and resulting follow up and consultation as required at hire, annually and as directed by Supervisor.
Perform other reasonably related duties as assigned by the immediate supervisor or other management as requested.
Assist with completing special assignments and necessary.
Work cooperatively and effectively with clients, staff, management and other professional and community groups.
Exercise mature judgment in dealing with people.
Present ideas clearly and accurately.
Read and comprehend the English language.
Communicate effectively, both orally and in writing.