Revenue Cycle Specialist

MISSION/VISIONHealthcare Alternative Systems (HAS) provides a continuum of multicultural and bilingual (English/Spanish) behavioral care and social services that empower individuals, families, and communities. HAS seeks to implement sustainable programs that benefit society by improving the well-being and recovery efforts of those individuals, families, and communities impacted by behavioral health problems. With eleven locations across the Chicagoland area, HAS provides services and resources to individuals at every stage in their behavioral/recovery journey so that they can be successful and become contributing members of their communities.

JOB SUMMARY Reporting to the Senior Vice President of Corporate Compliance, the Revenue Cycle Specialist is responsible for overseeing revenue cycle management including coding, billing, collections, and denial management as well as financial reporting within the organization. This position is responsible for ensuring claims, denials, and appeals are efficiently processed, and resolving billing-related issues. The Revenue Cycle Specialist will minimize bad debt, improve cash flow, and effectively manage accounts receivables.

This role will also manage Provider credentialing. The Revenue Cycle Specialist will be the main contact for the EDI vendor, Payer contacts, and Clearing House vendor. This position is to stay apprised of coding and revenue trends and is responsible for coding education billing staff.

ESSENTIAL DUTIESOversees and manages entire revenue cycle including billing, coding, collections, and denial management to DHS SUPR, Medicaid, MCO and Commercial insurance.

Maintains relationships with external vendors for practice management software and clearinghouse vendor.

Communicates professionally with various payers and provider representatives.

Manages and maintains billing and practice management software platform.

Updates reimbursement rates for all payers within the EHR.Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities and improvement strategies.

Reconciles all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements.

Manages and updates the EHR support staff on the current CMS/HFS fee schedule and negotiated contracts.

Conducts monthly analysis of Medicare/Medicaid/Third Party Payers.

Generates and manages revenue reports.

Reviews and resolves issues related to claim generation and rejected/denied billings.

Commits to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information.

Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations.

Maintains appropriate internal controls over accounts receivable, RCM process.

Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers.

Reviews, monitors, and evaluates third party reimbursement and researches variances.

Performs other duties as assigned.

REQUIRED SKILLS/ABILITIES Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process;

Proven experience in healthcare billing, including DHS SUPR, Medicare, Medicaid, MCO and Commercial Insurance;

Knowledge of basic insurance policies, authorizations, procedures, and reimbursement practices with and coding;

Experience with credentialing/re-credentialing of Facilities, preferred;

Prior experience with process development and execution;

Excellent communication and interpersonal skills;

Expert in Microsoft Excel and Word;

Bilingual is a plusHAS requires all staff to work on site.

EDUCATION & EXPERIENCEA Bachelor’s degree and 3-5 years of related work experience PHYSICAL REQUIREMENTS Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. The worker is…