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The Sylvia Brafman Mental Health Center

About UsWe are a leading national primary mental health treatment provider offering a full continuum of care, including residential, PHP, IOP, and outpatient services. Our organization is committed to delivering high-quality care while optimizing revenue cycle performance across our network.Position SummaryWe are seeking a highly skilled RCM Specialist with out-of-network (OON) expertise to support our revenue cycle operations. The ideal candidate will have hands-on experience in behavioral health medical collections, utilization review (UR), and billing, with a strong understanding of payer dynamics and reimbursement strategies in an OON environment.Key Responsibilities<ul><li>Manage revenue cycle processes with a focus on out-of-network (OON) billing and collections</li><li>Submit, track, and follow up on insurance claims to ensure timely reimbursement</li><li>Perform medical collections and aggressively pursue outstanding balances</li><li>Review, analyze, and resolve claim denials, underpayments, and rejections</li><li>Prepare and manage appeals and reconsiderations for OON claims</li><li>Collaborate with Utilization Review (UR) to ensure proper authorization, documentation, and medical necessity alignment</li><li>Verify benefits and understand OON reimbursement structures and policies</li><li>Post payments and reconcile accounts accurately</li><li>Communicate with insurance companies to negotiate and secure appropriate reimbursement</li><li>Maintain compliance with payer requirements and internal policies</li><li>Track KPIs including AR aging, collections performance, and denial trends</li></ul>Qualifications<ul><li>2+ years of experience in revenue cycle management with a strong OON focus</li><li>Proven experience in behavioral health medical collections, UR, and billing</li><li>Deep understanding of out-of-network reimbursement strategies and payer behavior</li><li>Experience handling appeals, denials, and underpayment recovery</li><li>Familiarity with behavioral health levels of care (PHP, IOP, residential, outpatient)</li><li>Experience with EMR systems (e.g., KIPU or similar) preferred</li><li>Knowledge of CPT/ICD-10 coding and claims lifecycle</li><li>Strong negotiation, problem-solving, and communication skills</li><li>Ability to work independently in a fast-paced, multi-site environment</li></ul>Preferred Qualifications<ul><li>Experience working in a multi-state or national behavioral health organization</li><li>Strong background in high-dollar collections and complex claims resolution</li><li>Advanced Excel or reporting skills</li></ul>Compensation &amp; Benefits<ul><li>Competitive salary (based on experience)</li><li>Health, dental, and vision insurance</li><li>Paid time off and holidays</li><li>Career growth opportunities within a national organization</li></ul>Pay: $50,000.00 - $80,000.00 per yearBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>behavioral health RCM: 3 years (Required)</li><li>medical billing and collections: 3 years (Required)</li><li>OON: 2 years (Required)</li></ul>Work Location: In person

RCM Specialist

Join The Sylvia Brafman Mental Health Center and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

The Sylvia Brafman Mental Health Center

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RCM Specialist