Revenue Cycle Specialist - Job Description

Shift: FT Days, M-F

Wonderful opportunity for a talented Revenue Cycle Specialist with our growing organization! The Raleigh House is seeking a well-rounded Revenue Cycle Specialist to join our Revenue Cycle Operations team. This is a critical role to facilitate our growth, focused on delivering excellence in our billing and collections (B&C) processes at the Raleigh House, including: insourcing of B&C cycle, implementing scalable B&C processes, weekly billing of insurance claims and ongoing collections of outstanding AR. This position will ensure that our clean claims are billed and collected in a timely manner,, while minimizing denials. This is a full-time position, based in our Denver Tech Center location with hybrid options available.

Job duties and expectations include, but not limited to:

• Passion for our mission at the forefront of all work.
• Support department by partnering with Utilization Review and other professionals to ensure a seamless revenue cycle process.
• Assist manager by reducing the Revenue Cycle Department 3rd party vendor usage, while collaborating with existing partners. Foster development of scalable processes
• Manage and execute the middle and end of the revenue cycle process, including: billing, coding, claims submission, payment posting, VOB’s, and collections. Ensure collaboration across the finance and operations function to produce accurate and timely submission of claims and maximize reimbursement.
• Analyze revenue, KPIs, and reimbursement trends to identify areas for improvement.
• Develop and implement strategies to optimize revenue, reduce denials, and improve collections.
• Provide regular reports and analysis to leadership.
• Ensure compliance with all applicable regulations, including HIPAA, CMS, and payor guidelines in all processes. Maintain and update current and accurate changes in billing and reimbursement rules and regulations.
• Evaluate and help implement new revenue cycle management software with a cross functional project team.
• Participate in all meetings and committees related to revenue cycle operations.
• Provide excellent customer service to patients, payors, fellow employees, and other stakeholders. Resolve billing-related inquiries and address any concerns or issues.
• Maintain high ethical standards and professional acumen at all times.
• Treat all HIPAA and sensitive information as confidential.
• Reports to the manager of Revenue Cycle Operations

Position specific experience and requirements:

• Insurance verification of benefits with knowledge of behavioral health preferred
• Proficiency with institutional claim adjudication with excellent documentation skills
• Experience with complex claim adjudication, administrative appeals, and medical record requests
• Experience with out of network claims life cycle
• Mastery of payment posting, paper and electronic ERA files, ANSI/adjustment coding
• Experience with modern EMR and billing systems, Alleva/CMD preferred
• Basic knowledge of healthcare contracts, credentialing and enforcement
• Desire to learn new ways to maximize revenue cycle opportunities
• Ability and willingness to engage any portion of claims life cycle to bring favorable adjudication
• Functional knowledge of individual payor portals and common electronic linkages, Availity, Verify Tx, etc.

Our ideal candidate will possess the following experience and attributes:

• Revenue Cycle experience in Behavioral Health or other healthcare services industry a must, including experience in inpatient and outpatient settings
• Collaborative approach, willing to partner closely with our utilization review and operations teams to ensure clean claims and audit compliance while working with other teams.
• Roll-up-your-sleeves attitude, willing to work in both the details and seeing the entire Revenue Cycle
• 3-5 years of Revenue Cycle experience
• Bachelors’ degree in Business Administration, Finance, or related field

Compensation: $65,000.00 - $80,000.00 DOE Max Midpoint $72,500.00

Our Commitment: These statements guide our actions, shape our organizational culture, and inspire us to make a positive impact on the lives of those we serve.

Our Mission: At The Raleigh House, we strive to deliver an inspiring client experience through personalized, evidence-based behavioral health services that empower individuals to rewrite their story and achieve long-lasting wellness through joyful, fulfilling lives. Our compassionate, mindful team of experts help clients build resilience and foster positive change as they progress through their journey.

Our Vision: Our vision for The Raleigh House is to be the premier provider of mental health, addiction, trauma assessment and services in Colorado and beyond. We endeavor to be recognized for our uncompromising quality service, expertise, and outstanding outcomes. We strive to create a world where healing and recovery are inclusive, stigma is eliminated, and our clients have access to high-quality, equitable care that supports their well-being.

Our Values:

1. Integrity: We uphold the highest ethical standards in all aspects of our work. We maintain strict confidentiality, protect client privacy, and act with honesty, transparency, and professionalism.

2. Clinical Excellence: We are dedicated to providing the highest standard of care by continuously improving our knowledge, skills, and practices. We embrace innovation, evidence-based approaches, and best practices in the field of behavioral health.

3. Compassion: We approach every individual with empathy, kindness, and understanding. We create a safe and non-judgmental environment where our clients feel valued and supported.

4. Empowerment: We empower individuals to take control of their mental health journey and make informed decisions. We provide them with the tools, resources, and support they need to build resilience, enhance their well-being, and achieve their goals.

5. Collaboration: We believe in the power of collaboration and teamwork. We work closely with our clients, their families, and other healthcare professionals to develop personalized treatment plans and ensure holistic care.

6. Respect: We treat every individual with respect and dignity, honoring their unique experiences, perspectives, and cultural backgrounds. We believe in fostering a culture of inclusivity, equality, and diversity.

At The Raleigh House, we value a diverse, inclusive workforce and we provide equal employment opportunity for all applicants and employees. All qualified applicants for employment will be considered without regard to an individual’s race, color, sex, gender identity, gender expression, religion, age, national origin or ancestry, citizenship, physical or mental disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military or veteran status, or any other basis protected by federal, state or local laws.

Job Type: Full-time

Pay: $60,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• Hybrid work

Experience:

• Revenue cycle management: 3 years (Required)

Ability to Commute:

• Denver, CO 80237 (Required)

Ability to Relocate:

• Denver, CO 80237: Relocate before starting work (Required)

Work Location: Hybrid remote in Denver, CO 80237