Revenue Cycle Specialist (Remote)

Changing Lives at Home (CLH) is a leading behavioral health organization dedicated to providing comprehensive behavioral health services. Our extraordinary team supports individuals through our five core programs, including Psychiatric Rehabilitation Program (PRP), Outpatient Mental Health Clinic (OMHC), Substance Use Disorder (SUD), Health Home, and Group Home services, ensuring compassionate, person-centered care while maintaining the highest standards of quality, compliance, and support for the communities we serve.

Summary

We are seeking a detail-oriented Revenue Cycle Specialist to support CLH's billing and reimbursement operations. This remote position is responsible for ensuring accurate claims processing, payment reconciliation, and accounts receivable management while maintaining compliance with payer requirements and agency policies.

Position Overview

The Revenue Cycle Specialist is responsible for managing and coordinating revenue cycle activities to support accurate and timely reimbursement from multiple insurance payers. The primary responsibility of this role is to reconcile insurance payments by reviewing Electronic Remittance Advice (ERA), Explanation of Benefits (EOB), and payment records to ensure accurate payment posting and identify payment discrepancies. This role works closely with the billing team responsible for claim submission by monitoring claim status, resolving reimbursement issues, and supporting accounts receivable activities.

The Revenue Cycle Specialist also verifies consumer insurance eligibility, benefits, coverage, and prior authorizations; maintains authorization records within the agency's electronic systems; prepares payment reconciliation and revenue cycle reports; collaborates with insurance payers, the billing team, providers, clinical staff, and leadership to support efficient and compliant revenue cycle operations; provides administrative support to the Executive Director; performs other duties as assigned; and ensures compliance with payer requirements, the Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission standards, and agency policies.

Key Responsibilities

Claims Processing & Billing

• Verify consumer insurance eligibility, benefits, coverage, and prior authorizations.
• Review claim information for accuracy and coordinate with the billing team responsible for claim submission.
• Monitor claim status and follow up on denials, rejections, payment corrections, and outstanding reimbursements.
• Communicate with insurance payers regarding claims, appeals, and reimbursement issues.
  

Payment Reconciliation & Accounts Receivable

• Reconcile insurance payments using Electronic Remittance Advice (ERA), Explanation of Benefits (EOB) documents, and payment records.
• Investigate and resolve payment discrepancies, underpayments, and overpayments.
• Post and reconcile insurance and patient payments.
• Monitor accounts receivable and maintain accurate billing and reconciliation records.
  

Revenue Cycle Management

• Analyze billing records and supporting documentation for accuracy and compliance.
• Maintain authorization records and prepare revenue cycle and reconciliation reports.
• Ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA), payer requirements, The Joint Commission standards, and agency policies.
  

Collaboration & Administrative Support

• Collaborate with insurance payers, the billing team, providers, and clinical staff to resolve billing and reimbursement issues.
• Provide administrative support to the Executive Director.
• Perform other duties as assigned.
  

Qualifications

• Bachelor's Degree required.
• Minimum of 2–5 years of experience in revenue cycle management, medical billing, payment reconciliation, or a related healthcare billing role.
• Experience with Mental Health Billing, including OMHC, PRP, and SUD, is required
• Strong knowledge of medical billing, claims processing, payment reconciliation, accounts receivable, and reimbursement practices.
• Experience working with Electronic Health Record (EHR) systems and medical billing software.
• Knowledge of HIPAA, healthcare regulations, Joint Commission standards, and payer requirements.
• Relevant certifications in medical billing or revenue cycle management are an advantage but not required.

Work Environment

This is a remote/work-from-home position requiring:

• A dedicated, quiet, and professional home office.
• A reliable high-speed internet connection.
• A computer or laptop.
• A headset with a noise-canceling microphone and clear audio quality.
• A webcam for virtual meetings.

What We Offer

• Competitive compensation
• Opportunity to work with a growing behavioral healthcare organization
• Supportive and collaborative team culture
• Opportunities for professional growth and development

Key Performance Indicators (KPIs)

Performance will be evaluated based on productivity, timeliness, accuracy, quality, and completion of assigned revenue cycle responsibilities. Expectations include:

• Maintain 99% accuracy in payment reconciliation and payment posting.
• Reconcile and post 95% of assigned insurance and patient payments within one (1) business day of receipt.
• Monitor assigned claims and follow up on 95% of claim denials, rejections, payment discrepancies, and outstanding reimbursements within established timelines.
• Resolve or document action taken on 95% of assigned payment discrepancies and reimbursement issues within five (5) business days.
• Maintain 100% same-day documentation of payment activities, reconciliation updates, claim status, authorization tracking, and follow-up notes in the designated billing system.
• Maintain 99% accuracy in authorization records and revenue cycle reports.
• Respond to internal billing requests and insurance payer inquiries within one (1) business day.
• Maintain 100% compliance with HIPAA, payer requirements, The Joint Commission standards, and company policies.
• Complete 100% of assigned daily work queues by the end of each scheduled workday, unless delayed by payer response or missing documentation.
• Attend 100% of required meetings, training sessions, and reporting deadlines, unless excused by management.

Performance expectations and Key Performance Indicators (KPIs) may be updated periodically based on operational needs and business requirements.