Job Summary:

The Revenue Cycle Collection Specialist is responsible for managing accounts receivable for mental health and substance use disorder services, with a primary focus on resolving unpaid and denied claims. This role ensures timely and accurate reimbursement through claim audits, denial resolution, appeals, and proactive follow-up with payers.

DUTIES, RESPONSIBILITIES, & ESSENTIAL JOB FUNCTIONS - qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

Essential Functions:

Review and resolve outstanding accounts receivable, including payer denials and underpayments

Perform timely claims follow-up with commercial and government payers

Identify root causes of denials (e.g., coding, authorization, eligibility) and take corrective action

Submit corrected claims and draft/submit appeals as needed

Maintain and work aging AR to reduce outstanding balances

Review and resolve credit balances

Verify and update patient demographic, financial, and insurance information

Ensure accurate documentation of all account activity in billing systems

Communicate with internal staff, patients, and payers to resolve billing issues

Evaluate accounts for accurate reimbursement based on payer contracts

Maintain tracking tools and reporting (Excel, internal systems)

Non- Essential Functions:

Participate in performance improvement and quality initiatives

Maintain confidentiality and compliance with all regulatory requirements

Represent the organization in a professional manner

Perform other duties as assigned

Professional Requirements:

Complete annual education requirements, if applicable

Maintains standards of professional society procedures and ethical behavior.

Maintain client confidentiality at all times.

Report to work on time and as scheduled.

Participate in performance improvement and continuous quality improvement activities.

Represent the organization in a positive and professional manner at all times.

Communicate the mission, ethics and goals of the organization.

Qualifications:

• High school diploma or equivalent required

• Minimum of 2 years of experience in healthcare billing, collections, or related revenue cycle role (behavioral health preferred)

Preferred:

• Experience with Kipu and CollaborateMD

• Experience with mental health or substance use disorder billing

Competencies - Knowledge, Skills, and Abilities:

• Strong understanding of UB-04, CMS-1500, EOBs, and payer requirements

• Knowledge of third-party payer regulations and reimbursement methodologies

• Ability to analyze denials and determine appropriate next steps

• Proficient in insurance verification and benefit interpretation

• Strong attention to detail and documentation skills

• Excellent communication and organizational skills

• Ability to prioritize and manage multiple accounts effectively

Ability to lift up to 25 pounds

Ability to navigate office environment, including stairs if needed

Flexibility in scheduling based on operational needs