Senior Revenue Cycle Specialist

Job Description

Job Description

We are a social enterprise that is actively changing the face of child welfare and are constantly searching for talented, purpose-driven professionals to join our community. We are a group of happy warriors, courageous mutants, and passionate pragmatists. Come join our island of misfit toys! 

Position Summary  

The Senior Revenue Cycle Specialist serves as the operational lead and subject matter expert for Revenue Cycle functions including per diem billing, fee-for-service billing, claim reconciliation denial management, appeals, accounts receivable follow-up, credentialing support, and revenue cycle process improvement.  

The Senior Revenue Cycle Specialist provides workflow guidance, training support, quality oversight, and operational leadership while partnering with the Revenue Cycle Manager to improve reimbursement outcomes, reduce denials, standardize processes, and support financial sustainability. 

This position provides operational leadership and workflow support but does not have direct supervisory responsibility. 

You Should Accurately Be Described As:  

You should be described as a collaborative, solution-focused professional who communicates clearly, follows through on commitments, and supports team success. You are detail-oriented and understand the importance of accuracy, timeliness, compliance, and strong reimbursement outcomes. You proactively identify barriers, research root causes, and help implement sustainable process improvements that support operational excellence. You demonstrate Necco’s values through accountability, ownership, measurable results, and commitment to the mission of building families. 

Revenue Cycle Leadership  

• Act as lead resource and subject matter expert for Revenue Cycle operations 
• Assist in establishing department standards, workflows, and best practices

• Provide guidance, training, onboarding, and cross-training support to Revenue Cycle team members

• Use data, trends, and root cause analysis to identify operational risks and reimbursement barriers and support measurable improvement 
• Communicate effectively with team members, leadership, payers, and operational partners to resolve issues and support collaboration 
• Assist Revenue Cycle Manager with special projects and strategic initiatives

Per Diem Billing Oversight  

• Serve as subject matter expert for per diem billing processes 
• Monitor billing timeliness and accuracy and identify and resolve billing issues impacting reimbursement

• Collaborate with operational teams to resolve authorization, census, and invoicing concerns

• Develop standardized billing procedures and training materials 

Fee-for-Service Billing Oversight  

• Serve as operational lead for fee-for-service (FFS) billing activities 
• Review billing workflows and identify opportunities to improve accuracy and reimbursement

• Monitor claim submission performance

• Provide support for complex billing issues and claim corrections 

FFS Charge Reconciliation  

• Perform and oversee charge reconciliation processes 
• Validate that services rendered are accurately reflected in billing systems and identify missing charges or revenue leakage

• Collaborate with clinical and operational teams to resolve discrepancies

• Recommend process improvements to reduce missed billing opportunities 

Denials & Appeals Management  

• Lead investigation and resolution of complex denials 
• Analyze denial trends and develop appeal strategies

• Prepare and submit high-value appeals

• Monitor appeal outcomes and identify opportunities for improvement

• Serve as escalation point for reimbursement disputes 

Accounts Receivable Management  

• Monitor aging accounts receivable and support reduction of aged balances 
• Assist team members with complex reimbursement issues

• Review productivity and reimbursement trends

• Escalate payer issues as needed 

Credentialing & Enrollment Support  

• Serve as Revenue Cycle liaison for credentialing-related reimbursement issues 
• Monitor credentialing impacts on billing and reimbursement and support escalation of enrollment and payer participation concerns

• Assist with development of credentialing workflows and tracking processes.

• Provide backup support during staffing gaps 

Coding & Documentation Oversight  

• Review coding-related billing trends and denial patterns and identify opportunities for coding education and documentation improvement 
• Collaborate with providers, operations, and leadership to address recurring coding concerns

• Assist with implementation of coding-related billing edits and workflow improvements

• Stay informed of coding and payer requirements affecting reimbursement 

Quality Assurance  

• Perform quality reviews of billing, payment posting, appeals, and accounts receivable follow-up activities with a focus on accuracy, accountability, and attention to detail 
• Monitor compliance with organizational policies and payer requirements

• Assist with auditing and quality improvement initiatives 

Process Improvement  

• Lead workflow standardization efforts and develop and maintain department job aids and process documentation 
• Assist with KPI development and monitoring and use results to identify barriers and support measurable outcomes

• Recommend automation and efficiency opportunities

• Participate in EHR and system improvement initiatives 

Success Measures  

• Supports timely and accurate billing, claim submission, payment posting review, and accounts receivable follow-up activities 
• Contributes to reduced denials, improved appeal outcomes, decreased aged receivables, and increased reimbursement recovery

• Maintains consistent workflow documentation, job aids, and training resources that support team efficiency and cross-training

• Demonstrates measurable progress toward departmental goals, quality standards, process improvements, and financial sustainability 

Corporate Citizen  

• Models Necco’s mission, vision, and values through professionalism, ownership, collaboration, and measurable results 
• Maintains a solution-focused approach when working with internal teams, external partners, and cross-functional stakeholders

• Protects confidentiality and supports compliance with organizational policies, payer requirements, and regulatory expectations

• Contributes to a positive team culture by demonstrating accountability, respect, continuous learning, and commitment to building families 

Position Qualifications  

• Minimum of five (5) years of experience in healthcare revenue cycle operations, with demonstrated expertise in billing, accounts receivable follow-up, denial management, and reimbursement recovery 
• Experience with Medicaid, Managed Care Organizations (MCOs), and governmental billing; behavioral health and per diem billing experience preferred

• Experience with EHR and clearinghouse systems

• Strong analytical, problem-solving, communication, and leadership skills, including experience training or mentoring team members