Revenue Cycle Specialist- LHCSA

Job Description

Job Description

Revenue Cycle Specialist- LHCSA

Lake Success, NY

The ideal candidate will have strong experience in healthcare billing, specifically within a New York LHCSA, with a solid understanding of Medicaid managed care, payer authorizations, claims submission, accounts receivable management, and denial resolution.

Job Summary: The Revenue Cycle Specialist is responsible for supporting and managing key revenue cycle functions for the Licensed Home Care Services Agency (LHCSA), ensuring that services provided are accurately documented, authorized, billed, and reimbursed in a timely manner. This position works closely with Operations, Intake, Scheduling, Clinical, Payroll, and Finance to ensure accurate claims submission, resolve billing discrepancies, monitor outstanding accounts receivable, and maximize reimbursement. This position reports to revenue cycle leadership and is responsible for an assigned group of payers.

The ideal candidate has experience with LHCSA home care billing, Medicaid managed care, payer requirements, authorizations, and the operational processes unique to LHCSA services.

Essential Duties and Responsibilities:

Billing and Claims Management

• Prepare, review, and submit claims to Medicaid, Managed Long-Term Care (MLTC) plans, Managed Care Organizations (MCOs), and other applicable payers.

• Ensure claims are submitted accurately and within established payer filing deadlines.

• Review billing data for accuracy, including patient eligibility, authorizations, service dates, units, rates, and required supporting documentation.

• Identify and resolve billing errors, claim rejections, and discrepancies.

• Monitor claim submission activity and maintain appropriate billing records.

Authorization and Service Verification

• Verify that services rendered are supported by valid payer authorizations and approved service plans.

• Monitor authorization periods, approved service hours, units, and service limits to identify potential billing issues.

• Coordinate with Intake, Scheduling, and Operations to address authorization discrepancies, expired approvals, and service delivery variances.

• Identify services rendered without appropriate authorization and escalate issues for timely resolution.

Accounts Receivable and Collections

• Monitor outstanding accounts receivable and follow up on unpaid, delayed, or denied claims.

• Research payment discrepancies and underpayments and coordinate resolution with payers.

• Review aging reports and prioritize accounts requiring follow-up.

• Identify recurring denial trends and recommend process improvements to reduce preventable revenue loss.

• Assist with payer inquiries, audits, and reconciliation activities.

• Prepare and file appeals, reconsiderations and timely filing requests, and track payer deadlines.

Payment Posting and Reconciliation

• Review and post insurance and Medicaid payments accurately and timely.

• Reconcile remittance advice, electronic payment information, and other payment documentation against submitted claims.

• Identify and research discrepancies between billed amounts and payments received.

• Escalate unresolved payment variances, contractual adjustments, and potential write-offs in accordance with established procedures.

Compliance and Documentation

• Maintain accurate and complete billing and reimbursement records.

• Follow applicable Medicaid, MLTC, MCO, payer, and organizational billing requirements.

• Support internal and external audits by retrieving and organizing requested billing documentation.

• Maintain confidentiality and comply with HIPAA and organizational privacy and security requirements.

• Identify potential compliance concerns, billing irregularities, or recurring process deficiencies and report them through appropriate channels.

Reporting and Process Improvement

• Prepare routine billing, accounts receivable, denial, and collection reports.

• Monitor key revenue cycle indicators, including claim submission, denial rates, payment turnaround, and outstanding receivables.

• Assist in identifying workflow inefficiencies and opportunities to improve revenue cycle performance.

• Collaborate with internal departments to improve communication, documentation, and billing accuracy.

Qualifications:

• High school diploma or equivalent required; Degree in business, healthcare administration, accounting, or a related field preferred.

• Three or more years of billing experience with a New York LHCSA or MLTC plan required.

• Knowledge of Medicaid eligibility, payer authorizations, claims submission, remittance advice, and denial resolution.

• Experience with HHAeXchange preferred.

• Proficiency with Microsoft Excel and other standard business applications.

• Experience with healthcare billing systems and electronic claims platforms preferred.

Working Conditions:

This position operates in an office environment.

Job type: Full-Time

Pay: $60,000.00-$65,000.00 per year