The Rev Cycle Case Manager is responsible for processing billing, payments, and other forms of billing for services rendered by providers. This role works collaboratively with clinical, medical, administrative, and executive team members to enable quality care coordination of services for educational and residential services. Facilitates the admission process and ensures admission related activities comply with established policies and procedures. Collects data and distributes reports pertaining to occupancy and referral sources. Facilitates the submission of documentation for prior authorization of Psychiatric Residential Treatment, Early and Periodic Screening Diagnosis and Treatment Medicaid funding, as well as assisting obtaining private insurance certifications. 

Essential Job Functions:

• Reviews and processes financial data for new and returning clients to ensure all document information is present to successfully bill and get paid for the expected services provided.
• Coordinates information with internal staff, departments and outside contacts, agencies in order to ensure various pieces are in place for Grafton to successfully get paid for services performed.
• Creates and processes billing for Medicaid, Medicare, Agencies, Commercial payers, and patients.
• Processes and balances payments and or denials received from payers or clients.
• Reviews client accounts for discrepancies or problems when an account is opened to conduct other business, as well as during scheduled reviews of outstanding balances. Makes corrections to accounts or transactions, following established guidelines and procedures.
• Creates and distributes financial reports to designated internal customers.
• Assists internal and external customers with billing questions and issues.
• Works closely with supervisor to communicate departmental issues and procedural problems.
• Provides training on billing processes or EHR as requested by supervisor.
• Processes write-offs and refunds to private pay and third parties.
• Monthly balancing of business processed.
• Assists in testing and updating the EHR system.
• Works with programmers on necessary updates to paper and electronic billing formats.

• Coordinates the admission process to include; review of applicant files for appropriateness of services, interview with referring agency, legal guardian and internal program, and on-site tour of the facility with referring agency
• Facilitates the receipt of historical documentation from the legal guardian, sponsoring agency, hospital, detention centers, or previous treatment provider.
• Other duties as assigned.

Minimum Qualifications:

• Bachelor’s degree in Social Work, Psychology or related field.
• 1 year of rev cycle, account receivables, and or admissions experience.
• 3 years of experience working at a residential facility.
• Knowledge of CSA/Medicaid funding processes.
• Knowledge of services accessible to special needs populations

EMPLOYEE BENEFITS

• Medical, dental and vision
• Flexible Spending & Health Savings Accounts
• 401(k), including an employer match up to $2,500 annually
• Generous Paid Time Off plan
• Education Assistance up to $5,250 annually
• Life Insurance
• Employee Assistance Program (EAP)
• Short-term disability (STD)
• Long-term disability (LTD)
• As Grafton is a 501(c)(3) non-profit, you may be eligible for federal student loan forgiveness

If you have issues applying or have any questions about this position, please reach out to us at hr@grafton.org 

Grafton is an equal employment opportunity employer and tobacco-free workplace.

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