REVENUE CYCLE SPECIALIST

Infinite Recovery LLC•Buda, TX

About The Position

The Revenue Cycle Specialist is responsible for supporting the full revenue cycle process within the behavioral health treatment setting including insurance verification with billings and collection claims submissions, payment posting, account follow-up and collections. This role combines the core functions to ensure timely, accurate reimbursement while maintaining compliance with payer requirements, regulatory standards, and organizational processes. The Revenue Cycle Specialist works collaboratively with clinical, admissions, utilization review, and finance teams and support financial sustainability and continuity of care.

Requirements

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
Ability to respond to common inquiries or complaints from customers.
Ability to communicate effectively through email.
Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Knowledge of Microsoft Office (Word, Excel and Outlook) as well as CRM platforms, specifically Sales Force.

Responsibilities

Verify insurance benefits, eligibility and coverage prior to or during admission.
Confirm payer requirements for behavioral health and substance use treatment services.
Coordinate with utilization review and admissions teams to support authorization processes.
Identify coverage limitations and communicate financial information per established protocols.
Accurately submit insurance claims for behavioral health services in accordance with payer guidelines.
Ensure claims reflect appropriate CPT, HCPSC, and diagnosis codes as documented in the clinical record.
Review claims for accuracy, completeness, and compliance prior to submission.
Monitor claim status and address rejections, denials, and payer requests in a timely manner.
Post insurance payments, adjustments, and patient payments accurately.
Recocile Explanation of Benefits (EOBs) and remittance advice.
Identify underpayments, overpayments, and discrepancies and initiate corrective action.
Maintain accurate account balances and documentation within billing systems.
Research and resolve denied or unpaid claims.
Prepare and submit appeals with appropriate documentation.
Track trends related to denials and communicate findings with leadership.
Ensure follow-up activity aligns with payer timelines and contractual obligations.
Conduct follow-up on outstanding insurance and patient balances.
Communicate professionally with payers, patients, and guarantors reading balances.
Establish payment plans when applicable and in accordance with organizational policy.
Maintain documentation of collection efforts and account notes.
Maintain compliance with HIPAA, payer contracts, and regulatory requirements.
Ensure billing practices align with clinical documentation standards.
Participate in internal audits, reviews, and compliance activities as required.
Works closely with clinical, admissions, utilization review, and finance teams.
Communicate billing issues that may impact reimbursement or patient care.
Participate in training, system updates, and process improvement initiatives.
Support accurate reporting related to revenue cycle performance.