Revenue Cycle Collections Specialist

Revenue Cycle Collections Specialist

The Revenue Cycle Collections Specialist is responsible for ensuring the accurate and timely adjudication of all third-party claims submitted to insurance carriers. This role plays a critical part in increasing cash collections and reducing aging in third-party accounts receivable (A/R). The ideal candidate will focus on timely A/R follow-up and resolution of outstanding patient account balances. Responsibilities include, but are not limited to: addressing payer denials, zero payments, submitting corrected claims, providing medical records, locating missing payments, initiating claim appeals, correcting posting errors, processing claim adjustments and write-offs, resolving credit balances, navigating payer and clearinghouse portals, and managing payer correspondence. This position requires strong communication skills, both written and verbal, to effectively interact with Commercial, Medicaid, and Managed Care payers, as well as Revenue Cycle Management (RCM) leadership. Successful candidates will be solutions-oriented, capable of conducting detailed research, and well-versed in payer guidelines, company policies, and third-party collection best practices.

Your Role and What You'll Do:

• Analyze and evaluate claim payments using internal systems and tools to ensure provider reimbursement aligns with applicable state fee schedules.
• Review payer documentation and follow up with insurance carriers via phone to confirm receipt of claims and facilitate prompt reimbursement.
• Investigate and resolve third-party payer claim issues, including initiating claim adjustments and resubmissions according to payer-specific guidelines.
• Follow up on submitted claims to ensure timely payment; escalate unresolved issues to payers, internal departments, or RCM leadership as needed.
• Evaluate payment and denial accuracy, apply payments appropriately to patient accounts, and identify bad debt write-offs and A/R adjustments per company policy.
• Detect and resolve duplicate or overpayments and process necessary corrections.
• Maintain communication with internal departments to gather missing patient or insurance information.
• Ensure compliance with HIPAA regulations and all applicable federal, state, and payer guidelines.
• Verify billing accounts against A/R ledger to confirm accurate payment posting.
• Clearly document all interactions in the EHR, including call details, contact information, and outcomes.
• Address denial issues within three (3) days of receipt.
• Submit required medical records and documentation for medical necessity reviews, denials, and appeal processes in a timely manner.
• Submit secondary claims promptly upon receipt of the primary remit to prevent payment delays.
• Work to reduce third-party accounts receivable (A/R) and improve days sales outstanding (DSO).
• Use electronic medical records (EMR) and billing systems efficiently.
• Collaborate effectively with team members, leadership, and other departments using strong interpersonal and communication skills.
• Support workflow across departments and assist with other duties as assigned.

Qualifications:

• This position requires onsite work at our corporate office in Addison, TX.
• Minimum 5 years of experience in the healthcare industry required.
• Minimum 5 years of experience in medical revenue cycle collections required.
• Minimum 5 years of experience in a behavioral health or medical clinic setting preferred, but not required.
• Strong attention to detail and commitment to high-quality work.
• Excellent judgment and decision-making skills.
• Clear and effective communication abilities.
• Proactive approach to identifying and resolving issues.
• Eagerness to learn and take on new responsibilities.
• Demonstrated resourcefulness, collaboration, and teamwork.
• Consistently uphold and reflect BI's core values in all professional interactions.