REVENUE CYCLE SPECIALIST

JOB DESCRIPTION
Job Title: Revenue Cycle Specialist
Department: Finance
FLSA Status: Exempt
 
SUMMARY
 The Revenue Cycle Specialist is responsible for supporting the full revenue cycle process within the behavioral health treatment setting including insurance verification with billings and collection claims submissions, payment posting, account follow-up and collections. This role combines the core functions to ensure timely, accurate reimbursement while maintaining compliance with payer requirements, regulatory standards, and organizational processes. The Revenue Cycle Specialist works collaboratively with clinical, admissions, utilization review, and finance teams and support financial sustainability and continuity of care.    

ESSENTIAL FUNCTIONS

• Verify insurance benefits, eligibility and coverage prior to or during admission.
• Confirm payer requirements for behavioral health and substance use treatment services. 
• Coordinate with utilization review and admissions teams to support authorization processes.
• Identify coverage limitations and communicate financial information per established protocols. 
• Accurately submit insurance claims for behavioral health services in accordance with payer guidelines. 
• Ensure claims reflect appropriate CPT, HCPSC, and diagnosis codes as documented in the clinical record. 
• Review claims for accuracy, completeness, and compliance prior to submission. 
• Monitor claim status and address rejections, denials, and payer requests in a timely manner. 
• Post insurance payments, adjustments, and patient payments accurately. 
• Recocile Explanation of Benefits (EOBs) and remittance advice. 
• Identify underpayments, overpayments, and discrepancies and initiate corrective action. 
• Maintain accurate account balances and documentation within billing systems. 
• Research and resolve denied or unpaid claims. 
• Prepare and submit appeals with appropriate documentation. 
• Track trends related to denials and communicate findings with leadership. 
• Ensure follow-up activity aligns with payer timelines and contractual obligations. 
• Conduct follow-up on outstanding insurance and patient balances. 
• Communicate professionally with payers, patients, and guarantors reading balances. 
• Establish payment plans when applicable and in accordance with organizational policy. 
• Maintain documentation of collection efforts and account notes.
• Maintain compliance with HIPAA, payer contracts, and regulatory requirements. 
• Ensure billing practices align with clinical documentation standards. 
• Participate in internal audits, reviews, and compliance activities as required. 
• Works closely with clinical, admissions, utilization review, and finance teams. 
• Communicate billing issues that may impact reimbursement or patient care. 
• Participate in training, system updates, and process improvement initiatives.  
• Support accurate reporting related to revenue cycle performance. 

The job duties listed in this job description may not be inclusive of all requirements of this position.  Other duties may be assigned by your supervisor.

SUPERVISORY RESPONSIBILITIES
 This job has no supervisory responsibilities.

COMPETENCIES
 To perform the job successfully, an individual should demonstrate the following competencies:
Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.
Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.
Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods.
Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.
Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.
Judgement - Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
 
QUALIFICATIONS
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

LANGUAGE SKILLS
 Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers.  Ability to communicate effectively through email.  Ability to effectively present information to top management, public groups, and/or boards of directors.

MATHEMATICAL SKILLS
 Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
 
REASONING ABILITY
 Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

COMPUTER SKILLS
 To perform this job successfully, an individual should have knowledge of Microsoft Office (Word, Excel and Outlook) as well as CRM platforms, specifically Sales Force.

PHYSICAL DEMANDS
 The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this Job, the employee is regularly required to talk or hear.  The employee is frequently required to stand; walk and sit.  The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision and distance vision.

WORK ENVIRONMENT
 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderate.