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Soar Autism Center · 13 hours ago

Revenue Cycle Specialist (Billing)

United States

Full-time

Onsite

Entry, Mid Level

$60K/yr - $68K/yr

2+ years exp

Soar Autism Center is an innovative healthcare provider focused on autism care, seeking a Revenue Cycle Specialist (Billing) to join their team. The role involves managing billing processes, submitting claims, and optimizing revenue cycle operations to support the organization's growth in delivering services to children with autism.

ChildrenHealth CareMedicalTherapeutics

Responsibilities

Primary & Secondary Claim Generation

Audit billing entries for accurate coding and modifiers

Audit billing entries for diagnosis, authorization, provider and location

Identify and flag pre-claim MUE’s

Send secondary claims once primary has fully adjudicated and paid their portion

Send claims through the clearinghouse

Audit clearing house for rejections, correct claims and send

Reconcile electronic payments received in practice management software (CentralReach)

Accurately label denials and claims ready for secondary billing

Retrieve EOB’s/ERA’s from payor portals for manual posting

Evaluate, troubleshoot, and communicate with payors on claims that have been denied

Review & interpret payor contracts/rules to ensure accurate coding on all claims

Work cross-functionally with team members to resolve any discrepancies preventing claims being paid related to appointments, insurance, authorizations, etc

Stay up to date and research specific payor billing rule changes and update internal resources accordingly

Understand and monitor key metrics related to work performance

Team mentality. Foster a positive work environment for colleagues

Ensure strict HIPAA-compliant confidentiality with all client-related data

Ensure the accurate and timely creation and sending of patient invoices

Liaise with team members and clients to explain patient benefits and charges

Manage Soar’s backlog of denied and pending claims to ensure RCM team metrics focused on A/R aging is consistently at/above target, including

Fix and resubmit denied claims in a timely manner and in rare circumstances, coordinate with the VP of RCM to write-off certain claims

Conduct root cause analysis on drivers of denied claims and regularly provide suggestions on ways to improve the RCM team’s “1st pass clean claim rate”

Qualification

CentralReachHealthcare billing experienceRevenue cycle managementExcelGoogle SheetsHealthcare compliance knowledgeInterpersonal skillsAttention to detailCritical thinkingCommunication skills

Required

Bachelor's degree required (or equivalent work experience)

Minimum 1+ year of experience managing billings for an ABA therapy provider through using CentralReach

Minimum 2-4 years of healthcare claims and payment posting experience, with direct experience in ABA

Minimum of $10 million in annual billings managed

Minimum of 6 months experience working with Office Ally as a clearinghouse

Experience working directly with both commercial insurance companies as well as state Medicaid programs

Demonstrated success working with others in a high-growth environment

Expert-level knowledge of healthcare industry regulations, ABA billing requirements, and revenue cycle best practices

Proficient in excel or googlesheets

Strong interpersonal skills, capable of effectively collaborating with cross-functional teams and external payors

Understands core principles of healthcare compliance and how they are applied in an autism care setting

Exceptional attention to detail, critical thinking, and excellent communication with clients and insurance companies

Preferred

Experience with speech therapy, occupational therapy and psychology as well is strongly billing preferred

Proficient in healthcare revenue management platforms (CentralReach preferred)

Benefits

Comprehensive package including medical, dental, vision, 401(k) with match after a year of service, 10 days PTO, and professional development opportunities