Revenue Cycle Specialist III

Hybrid Position &

Location:

Hybrid Position &

Location:

role is hybrid and requires residency within a 30-mile radius of the 80230 area. The schedule includes 3 days onsite (Tuesday, Wednesday, Thursday) and 2 days remote (Mondays and Fridays).

With 30 locations throughout the U.S. and treatment options available virtually, ERC Pathlight meets patients where they’re at to offer innovative, compassionate and comprehensive treatment for eating disorders, as well as mood, anxiety and trauma-related disorders.

We were founded in 2008 by pre-eminent psychiatrists and psychologists and treat 6,000+ patients per year. With the critical need for mental health care and eating disorder treatment, especially during the Covid-19 pandemic, we’re looking for passionate and qualified professionals who will live out our mission to help save the lives of our patients.

The Revenue Cycle Specialist III (RCS-III) is responsible for working closely with the Supervisor and the RCS Manager to ensure that Business operations are working correctly and efficiently. The RCS-III is responsible for assisting insurance claims management by running Practice Management reports and reporting the finding to the supervisor and RCS Manager. The RCS-III must be committed to consistently modeling ERC Pathlight’s core values and ensuring a positive, results-oriented, and reliable customer experience.

The Revenue Cycle Specialist III is responsible for denial management functions for the revenue cycle department by monitoring and reporting on payor denial and slow-pay trends and conducting root-cause analysis. This position will interact and meet with teammates within the department who require assistance in effectively problem solving a specific account level denial, manage a set of assigned escalated accounts, and partner with department leadership and SMEs to develop and maintain denials management training and guidelines.

This position requires both strong critical thinking and communication skills and will partner with management and teammates in Revenue Cycle, Patient Access, Utilization Review, Medical Records, Training & Process Optimization and Business Analysts teams.

• Analysis
  • Analysis completed regularly utilizing available application systems (ex. Practice Management (PM), Electronic Data Interchange (EDI), Data Warehouse) to identify denied payor trends and patterns.
  • Root‑cause analysis related to identified trends or specific escalated accounts and delivering recommendations for any necessary education and or process change(s) and share findings with leadership stakeholders.
• Accounts Receivable Insurance Claims Follow‑up
  • Accountable for monitoring and resolution of specific accounts in delayed/open/unpaid status as assigned by leadership.
  • Call/Email Insurance Payors to resolve unpaid delayed/open/unpaid claims.
  • Navigating Insurance Payor portals to resolve unpaid claims.
  • Using denials management software (EDI), updates and maintains denials trending reports for distribution to users.
  • Process Medical Records Requests when needed.
  • Process requests for claim adjudication or additional adjustments when needed.
• Collaborate with teammates as needed to provide advice, consultation, observation, and training regarding claims management process, process changes and identified best practices (e.g. EDI utilization and optimization).
• As appropriate, attend available payor webinars and trainings, monthly monitoring of payor websites/listservs for applicable notices, newsletters or process change notifications. Share learnings with teammates.
• Customer Service
  • Answer phone calls from insurance companies in the queue.
  • Assist other departments with patient concerns/questions when needed.
• Systems Maintenance
  • Submit Practice Management edits to Revenue Integrity Team & Data Business Analysts.
• Help Onboard and train new teammates and support any knowledge transfer as needed.
• Other duties as assigned.

• High School or GED - Required
• 3‑5 years of healthcare revenue cycle experience - Required
• 3‑5 yrs behavioral health, commercial and government payor revenue cycle experience - Preferred
• 2‑…