Revenue Cycle Specialist

Reports to:Director of Revenue Cycle
FLSA Status:Exempt / Full Time
Compensation:$55,000 - $65,000 per year
Location:Onsite - Corporate Location, San Antonio, TX

Job Summary

The Revenue Cycle Specialist at Empower Behavioral Health (EBH) is a key member of the revenue cycle management team responsible for independently managing billing, claims, payment, accounts receivable, and denial activities. This position supports timely and accurate reimbursement by researching and resolving claim issues, managing denials and appeals, communicating directly with payers, reconciling payments, and monitoring outstanding accounts.

The Revenue Cycle Specialist is accountable for assigned revenue-cycle activities from initial review through resolution and must be able to independently prioritize workload, identify root causes, resolve issues, and maintain accurate documentation in a fast-paced, growing organization.

Duties and Responsibilities

• Prepare, review, and transmit claims in accordance with payer requirements and organizational standards.
• Monitor assigned claims and accounts receivable to identify outstanding, rejected, denied, delayed, or underpaid claims and take timely action to resolve them.
• Communicate directly with payers by phone, portal, and email to research and resolve claim, payment, and reimbursement issues.
• Independently manage assigned denials from identification through resolution, including determining root causes, taking corrective action, gathering supporting documentation, submitting appeals, correcting claims, and completing payer follow-up.
• Identify recurring denial and claim issues, analyze root causes, and recommend corrective actions to improve reimbursement and reduce avoidable denials.
• Research and resolve payment variances, underpayments, and account discrepancies to ensure accurate reimbursement and account balances.
• Complete payment posting and reconciliation of Explanation of Benefits (EOBs) and payer remittances as needed.
• Maintain accurate documentation of claim activity, denial resolution, appeals, payer communications, payment issues, and account follow-up.
• Monitor daily billing activities and assigned workflows to ensure timely processing, follow-up, and resolution.
• Respond to medical records and payer documentation requests in a timely and accurate manner.
• Prepare information and participate in weekly meetings, providing updates on claims, denials, appeals, payment issues, and identified trends.
• Identify opportunities to improve billing, claims, denial management, and payment processes and communicate recommendations to leadership.
• Escalate significant negative trends, compliance concerns, systemic payer issues, or matters requiring management-level intervention to the appropriate leader.
• Maintain confidentiality and comply with organizational policies, payer requirements, and applicable regulatory standards.
• Perform other revenue-cycle duties as assigned.
• Planning and Workload Management
• Problem Solving and Analytical Thinking
• Attention to Detail and Accuracy
• Revenue Cycle and Claims Knowledge
• Denial Management and Resolution
• Results-Oriented
• Customer Service
• Communication
• Organization and Prioritization
• Accountability and Follow-Through

Role Scope

The Revenue Cycle Specialist independently manages, and resolves assigned revenue-cycle responsibilities and is accountable for timely follow-up, accurate documentation, effective payer communication, and completion of assigned work.
The Revenue Cycle Specialist Lead builds on these responsibilities by providing guidance and support to Specialists on complex accounts, denials, payer issues, and other matters requiring additional knowledge or judgment. The Lead serves as a resource for Specialists while maintaining responsibility for their own…