Revenue Cycle Specialist I

Position: Revenue Cycle Specialist I Job Type: Pool; Non-Exempt Temporary Up To 12 Week Assignment Shift Details: Pool: Shift Hours and Days as Needed up to 15 hours a week. (depending upon the state chosen, those hours can differ) - All pool staff, regardless of type, must be available to work at least 2 shifts per month to include the following holidays: Christmas, New Years Day AND One other major holiday: Memorial Day, Fourth of July, Labor Day, and Thanksgiving Day *Please note the 2 shifts will be offered based on the provided availability by the employee. New employee orientation is three full days and does require attendance for all days. Training is Monday, Tuesday, and Wednesday onsite and full days' attendance is required.

Work Location: Remote - Must Reside In AZ, DE, FL, LA, MA, MD, MI, NC, OH, OR, PA, TN, TX, UT, or WA Salary/Hourly Wage: $23.50/hrDuties / Responsibilities: Responsible for managing and maintaining a workload of approximately seventy (70) claims to resolution daily. Use Microsoft Teams for daily communication and collaboration and utilize Microsoft Office products, primarily Excel. There is potential for this role to become permanent, based on performance and business needs.

Essential Duties and Responsibilities: Billing and Account Management:

• Works in conjunction with other RCM staff to assure timely completion of billing functions.
• Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher to ensure claim(s) resolution.
• Review outstanding claims to determine necessary action. Make status calls to insurance companies.
• Request claims to be reprocessed when necessary and prepare/submit corrected claims or appeals to the insurance companies for payment. Adjust claims that are deemed non-reimbursable.
• Monitor payer project work queues for both pending and submitted claims; move claims between work queues while documenting.
• Claims Review and Reconciliation:
• Review underpayments and overpayments, prepare spreadsheet and summarize findings; escalate as appropriate.
• Post contractual allowances based on fee schedule or expected payment/denial amounts per third party contracts.
• Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.
• Call payers to determine the true reason for denial and inquire on what corrections need to be made.
• Investigate receipt of claims and payer portals to maximize reimbursement.
• Reporting and Communication:
• Create and distribute specific reports to staff such as the account detail report, unbilled report and any other claims detail report for proper follow-up as needed.
• Prepare and submit denied claims targeted project files to payers, track reprocessing of project files.
• Provide feedback to both department and payers on project status.
• Maintain tracking sheet of pending/resolved issues and historical payer issues.
• Schedule and attend departmental meetings/conference calls.
• Coding, Compliance, and Documentation:
• Knowledge of CPT, HCPCS, and ICD-10 codes
• Identify problematic claim trends and contract violations and report findings to the Manager and Director.
• Follow company processes related to submission of corrected claims and appeals.
• Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.

Additional Duties: Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies. Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies and procedures as they presently exist and as they change or are modified. Performs other related duties as assigned. Your well-being and success are our priority at RI—explore our benefits and discover how we invest in YOU every step of the way! As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and generous paid time off to support work-life balance. In addition, we provide ongoing opportunities for professional development and training to help you advance in your career. We value the contributions of our team members and are dedicated to fostering a supportive, inclusive environment where you can thrive both personally and professionally.

Job Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education: High school diploma or equivalent.

Experience: 2 years of medical billing (preferably Behavioral Health) and/or A/R experience preferred. Preferable experience in either Arizona and/or Washington markets. Working knowledge of CMS guidelines, contracted insurance guidelines and coding policies. Demonstrated computer skills.

Skills: Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment. Intermediate to Advanced proficiency in Microsoft Excel. Must have excellent written and verbal communication, with particular emphasis during telephone calls, follow-ups, and in-person correspondence. Prior training experience is preferred. Above average computer skills including databases, spreadsheets, interface file maintenance and related computer programs designed for billing, coding, and accounting purposes. Ability to focus on the big picture while attending to multiple detail requirements in a changing environment. Ability to analyze and interpret data. Ability to formulate, recommend and implement solutions. Ability to adapt to change in the workplace and demonstrate the ability to work collectively within a diverse team environment. Ability to use critical thinking and reasoning skills to solve a problem. Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas. Ability to find a solution for or to deal proactively with work-related problems.

Driving Requirements: If driving is required for this position, must meet all requirements outlined in Recovery Innovations driving policy. If not qualified to drive per driving policy, a Non-Driver Attestation form must be signed.

Physical Demands: May include work close to the eyes and substantial motions of the wrist, hands, and/or fingers. Frequent sitting, standing, walking, handling, finger dexterity; eye-hand-foot coordination, use of corrected vision; color vision;