Revenue Cycle Specialist

Job Details

Job Location:

Ardmore Bldg D - Ardmore, OK 73401

Salary Range: $25.55 - $25.55 Hourly

Travel Percentage:
Negligible

Job Shift: Day

A Lighthouse is needed to help guide the way; to emit a light that helps navigate turbulent times and warn against the possible dangers ahead. Lighthouse Behavioral Wellness Centers is just such a place, guided by its core values of hope, dedication, and community.

As a Revenue Cycle Specialist, you will participate in activities involved in the review, adjustment and collection of claims and claims denials for all Medicaid, Medicare, and Private Insurance payers. You will assist in taking all steps necessary to ensure that claims are correct and meet billing standards for submission. Furthermore, you will assess and monitor trends and work closely within the Revenue Cycle team environment to ensure resolution and establish best practices and workflows to prevent future errors.

To meet the increasing needs of our communities it is imperative that all team members understand and successfully reach and maintain the expected performance standard levels. In order to achieve total and sustainable success, each person must do their part. Lighthouse will do its part in providing any necessary tools and training required to help team members be successful.

• High school diploma or its equivalent
• Experience in the medical field, medical billing/claims, explanation of benefits, denials, or medical billing preferred.

• Ability to develop working relationships with clinical staff and supervisors.
• Must be a self-starter and able to work independently, as well, as in a team environment.
• Must be very detail oriented and possess the ability to multi-task.
• Proficient in utilizing Excel and Word.

• Demonstrating a level of competence and understanding of state and federal rules and regulations regarding payer billing standards.
• Understanding billing payers and their priorities for client accounts.
• Provides support to all Revenue Cycle Team members and leadership.
• Process ODMHSAS, Medicaid, Medicare, and private insurance claims in a timely manner.
• Identify client account errors by utilizing error reports to prevent billing errors, denied claims, and missed filing.
• Identify client account errors that prevent billing, such as missing CDC or client setup errors, and report to direct supervisor for correction.
• Resolving payer rejections from the electronic health record (EHR) prior to billing submission.
• Perform Medicare and private insurance corrections to claims and resubmit to payer.
• Correct denied OHCA and ODMHSAS claims and resubmit through OHCA portal.
• Appeal claims when appropriate according to payer rules.
• Research payments and posts non-electronic EOB’s to accounts timely to accurately reflect monies received.
• Review, work and document private insurance and Medicare coverage verification daily and report any discrepancies to direct supervisor for review.
• Reporting error trends, claims denial trends, and contract billing issues to the Director of Revenue Cycle and Compliance weekly.
• Assists Director of Revenue Cycle and Compliance, and Accounting with the reconciliation of accounts.
• Reviews client accounts prior to appointment communicating CDC or prior authorization needs to clinic Navigators, Clinicians, and Leadership as needed.
• Review Crisis accounts, both current admissions and recently discharged, to ensure accuracy in CDC or prior authorization to ensure claim submission success.
• Verify ODMHSAS, Medicare, Medicaid, and private insurance coverage requirements and work to ensure that all services have the necessary approvals in place prior to bill generation.
• Review and correct CDC and prior authorization errors prior to…