CMH REVENUE CYCLE SPECIALIST (Community Mental Health) - Control No.: 2609-5100-1606-0001

INTERNAL UNION APPLICANTS WILL BE GIVEN FIRST CONSIDERATION FOR UNION POSITIONS Under the general supervision of a higher classified employee, is the primary resource for back-end revenue cycle functions within Washtenaw County Community Mental Health (WCCMH), and is responsible for managing post-submission claim activity, including denials, accounts receivable follow-up, payment discrepancies, and payer-related issue resolution. Identify trends in claim outcomes and elevate reoccurring issues. Supports the financial performance of the organization by ensuring claims are resolved accurately and in a timely manner across managed care plans, and insurance carriers. EXAMPLES OF DUTIES Conduct root-cause analysis on reoccurring denials and develop recommendations for continuous improvement mindset and experience in workflow optimization. Review and resolve denied, rejected, underpaid or unpaid claims across all payers, including managed care plans. Prepare and submit corrected claims and appeals as appropriate. Ensure timely follow-up on outstanding claims to prevent aging and revenue loss. Investigate claim issues that require review beyond standard billing corrections. Monitor assigned accounts receivable and prioritize follow-up based on aging and payer requirements. Resolve claim status issues, including payment delays, reprocessing requests, and coordination of benefits concerns. Outreach to outside vendors and payers and maintain accurate and detailed documentation of all actions taken on accounts. Review accounts for potential write-offs in accordance with organizational policy and prepare documentation and recommendations for write off approvals. Monitor trends in write-offs and elevate concerns related to recurring adjustments or potential revenue leakage. Prepare and maintain A/R reports as needed. Elevate recurring trends or system-related issues to leadership for further review. Work with clinical, IT, credentialing and billing specialists to correct insurance layer issues, payment errors, and any other concerns that would prevent claims from processing correctly the first time. Investigate consumer accounts for missing insurance layers and work with credentialing team for corrections. Work with Executive leadership and follow up with providers on assigned projects as needed. Performs other duties as assigned. The above statements are intended to describe the general nature and level of work being performed by employees assigned this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. EMPLOYMENT QUALIFICATIONS Knowledge, Skills, and Abilities: Strong problem-solving and analytical skills. Ability to prioritize and manage multiple claim issues effectively. Clear and professional communication with internal teams and external payers. High level of attention to detail and accuracy. Intermediate to advanced understanding of Excel. Understanding of CPT/HCPCS, ICD-10 and Modifiers used during billing. Negotiation and conflict resolution skills working with payers and providers. An ability to train and mentor others. Ability to recognize patterns and elevate issues appropriately. Experience working with managed care payers and insurance carriers and/or behavioral health billing is preferred. Familiarity with CHAMPS system, clearing houses and Electronic Medical Records. LICENSES/CERTIFICATIONS Specified positions may require possession of a valid driver's license. PHYSICAL DEMANDS Duties require sufficient mobility to work in a normal office setting and use standard office equipment including a computer, vision to read printed materials and a computer monitor, and hearing and speech sufficient to communicate in person or over the telephone. These requirements may be accommodated for otherwise qualified individuals requiring and requesting such accommodation. EDUCATION Equivalent to possession of a bachelor's degree in healthcare administration, business, or a related field. Certifications relevant to billing, coding and revenue cycle are preferred. EXPERIENCE Three (3) years of experience in revenue cycle operations, budgeting, finance administration, or healthcare billing required. Experience in a public agency preferred. This class description intends to identify the major duties and requirements of the job and should not be interpreted as all-inclusive. Incumbents may be requested to perform job-related duties other than those outlined above and may be required to have specific job-related knowledge for successful job performance. #J-18808-Ljbffr Washtenaw County Health Department