Billing & Revenue Cycle Specialist
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AI Summary
The specialist manages the full revenue cycle, including insurance verification, claim submission, denial management, and payment posting. They also collaborate with clinical staff to ensure accurate documentation and maintain compliance with regulatory standards.
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Health insurance
- Paid time off
Abria Detox is seeking a detail-oriented Billing and Revenue Cycle Specialist to support the revenue cycle for our Withdrawal Management (245F) program. This hands-on role is responsible for insurance verification, prior authorizations, claim submission, payment posting, denial management, accounts receivable follow-up, and payer communication to ensure timely and accurate reimbursement. The Billing and Revenue Cycle Specialist will utilize the Ritten electronic health record while maintaining compliance with Minnesota DHS regulations, payer requirements, and organizational policies.
Essential Responsibilities
- Verify insurance eligibility and benefits prior to admission.
- Submit and manage initial, concurrent, and extension authorization requests.
- Track authorization expiration dates and approved units to ensure uninterrupted coverage.
- Submit, monitor, and reconcile insurance claims for Withdrawal Management services.
- Investigate and resolve rejected, denied, and underpaid claims through corrections, appeals, and payer follow-up.
- Monitor accounts receivable and follow up on outstanding insurance balances.
- Post insurance payments, contractual adjustments, and payment corrections accurately.
- Audit claims for coding, documentation, and service line accuracy prior to submission.
- Communicate with insurance companies regarding authorizations, claims, payment status, and appeals.
- Collaborate with admissions, nursing, and clinical staff to obtain documentation supporting medical necessity and reimbursement.
- Monitor payer updates and maintain current knowledge of payer requirements and reimbursement guidelines.
- Identify revenue cycle trends and recommend process improvements to reduce denials and improve cash flow.
- Participate in internal and external billing audits while ensuring compliance with HIPAA, Minnesota DHS regulations, and organizational policies.
Qualifications
- High school diploma or equivalent required; associate's degree preferred.
- Minimum of two years of behavioral health or substance use disorder treatment billing experience.
- Experience with Ritten, or similar electronic health record/billing systems preferred.
- Knowledge of Minnesota Medicaid (MHCP), commercial insurance billing, authorizations, and DAANES reporting preferred.
- Strong organizational, communication, and problem-solving skills with exceptional attention to detail.
Work Location: This is a fully remote position. Employees must maintain a reliable internet connection and a private, HIPAA-compliant workspace. Attendance at one mandatory Microsoft Teams meeting each month is required.
This is a remote position.
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