Revenue Cycle Support

Description

Zepf Center has been serving the Lucas County community for over 50 years. We are the leading provider of behavioral health and substance use disorder services in Northwest Ohio. Services include adult and child psychiatric, substance abuse, case management, residential, Crisis Care, and therapy programs, as well as career development and wellness services. Zepf Center also offers primary care medical services to our patients to contribute to their continuum of care. Zepf Center is a trauma-informed agency and environment for both patients and staff. 

General Summary:

The Revenue Cycle Support position is responsible for ensuring timely and accurate reimbursement through proactive management of patient eligibility, prior authorizations, provider credentialing support, and claims-related activities. This role serves as critical support to the Billing and Revenue Cycle teams to reduce denials, prevent revenue leakage, and support compliant billing practices.

Hours: Monday - Friday; 8:30am - 4:30am

Essential Duties and Responsibilities:

Eligibility & Benefits Verification

• Verify patient insurance eligibility, benefits, and coverage for services rendered.
• Keep EHR updated with current and accurate coverage plan information from 270/271 and client insurance card scans.
• Ensure necessary reallocations are performed for timely and accurate billing.
• Communicate eligibility findings clearly to other members of the Revenue Cycle and clinical teams as needed.
• Identify and communicate coverage limitations, exclusions, authorization requirements, and coordination of benefits issues.
• Resolve eligibility-related claim rejections and denials.

Prior Authorization Management

• Obtain, track, and document prior authorizations in accordance with payer and regulatory requirements.
• Review clinical documentation and coordinate with clinical team to ensure alignment with authorization requests.
• Monitor authorization status, follow up with payers and clinical staff as needed to ensure authorizations are in place to cover services provided, and escalate urgent or complex cases.
• Maintain accurate records of authorization requests, approvals, and denials within the EHR to support claims submission and audit readiness.

Credentialing & Enrollment Support

• Support provider credentialing, re-credentialing, and payer enrollment activities.
• Coordinate with providers, payers, and other members of the credentialing team to ensure enrollment is completed timely and accurately.
• Maintain provider demographic and enrollment data across revenue cycle systems.
• Assist in resolving credentialing-related payment delays or denials.

Claims Support & Denial Prevention

• Work with Billing Systems Manager to ensure claims are reviewed and modified as necessary for accurate and timely billing.
• Troubleshoot claim rejections within clearinghouse and EHR related to eligibility, authorization, and credentialing issues.
• Collaborate with Billing Systems Manager and billing team on denials to resolve payer-specific issues.
• Identify trends and root causes contributing to preventable denials and recommend process improvements.
• Perform other duties as assigned.

Specific/Individual Competencies:

• Requires a high level of accuracy, attention to detail, self-directed follow-up, accurate record keeping
• Proven ability to learn and apply new knowledge.
• Confidentiality in handling all provider, client, and agency information.
• The ability to work independently and independently manage timelines, projects and deadlines.
• The ability to prioritize and adapt quickly to changing needs and assignments.
• Highly proficient in Microsoft office products.
• Superior customer service skills; ability to work with all levels of staff. 
• The ability to develop a robust understanding of health center and behavioral health billing, credentialing, authorization, and service requirements.

Organizational Competencies: 

• Demonstrate knowledge of the agency mission, vision, goals, and philosophy as well as the policies and procedures.
• Demonstrate consistent professionalism.
• Demonstrate teamwork.
• Abide by the agency’s and/or professional code of ethics. 
• Strives to improve own and agency operations
• Commit to cultivating a non-violent and trauma-informed environment for all employees and clients, through our pursuit of Sanctuary; a trauma-informed model. Commit to a deeper exploration of Sanctuary Values.
• Incorporates Sanctuary techniques into daily work activities. 
• Participates in Sanctuary process teams and/or supports Sanctuary initiatives

Requirements

Position Qualifications: 

• High school diploma or equivalent required; associate’s degree in healthcare administration or related field preferred.
• 2–4 years of experience in healthcare revenue cycle operations, with emphasis on eligibility, authorizations, claims or credentialing.
• Working knowledge of insurance plans, payer guidelines, and medical billing and credentialing.
• Proficiency with EHR and practice management systems.
• Strong attention to detail, organizational skills, and problem-solving ability.

Those eligible to drive company vehicles must have a valid driver's license and be eligible for coverage as defined by the agency commercial insurance carrier. Those who drive personal vehicles in the course of business must be able to provide proof of insurance.