Revenue Cycle Billing Specialist

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 Revenue Cycle Billing Specialist is responsible for managing the billing and reimbursement lifecycle to ensure accurate claim submission, timely reimbursement, payment posting, denial resolution, regulatory compliance, and effective collaboration with internal and external stakeholders. This role supports the organization's revenue cycle performance through proactive accounts receivable management, accurate payment posting, customer service, and adherence to Necco's corporate culture and operational standards.

You Should Be Accurately Described As:

A detail-oriented and solutions-focused professional who demonstrates accountability, strong communication skills, critical thinking, and a commitment to supporting organizational success through effective revenue cycle operations. You are resourceful, adaptable, and committed to continuous improvement while maintaining a high level of accuracy and customer service.

Claims Management & Accounts Receivable

Utilize the Electronic Health Record (EHR) system to generate claims for per diem and fee-for-service billing and submit invoices to payers

Review and act on submitted claims within established timeframes to ensure timely reimbursement and resolution

Monitor, investigate, and resolve held, rejected, denied, underpaid, or unpaid claims utilizing EHR, clearinghouse, and payer portal resources

Submit corrected claims, reconsiderations, and appeals as appropriate

Work assigned accounts receivable reports and prioritize follow-up activities based on aging and reimbursement risk

Maintain accurate, organized documentation related to billing activities, claim follow-up, and claim outcomes

Apply critical thinking to identify reimbursement trends, recurring claim issues, and workflow barriers; resolve issues within the scope of the role and escalate recurring or material concerns to Revenue Cycle leadership

Collaborate professionally with internal departments to obtain information necessary for timely and successful claim resolution

Payment Posting Accurately post insurance, state, county, or other payer payments, denials, contractual adjustments, refunds, and other payment transactions within the Electronic Health Record (EHR) system

Review Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) documentation for accurate posting

Research and resolve payment posting discrepancies, variances, and exceptions

Investigate unapplied or unmatched remittance activity and coordinate resolution with appropriate internal teams

Maintain documentation related to payment posting activities and outcomes

Identify and communicate payment trends, patterns, or concerns that may impact reimbursement or operational efficiency

Assist with quality assurance reviews to ensure posting accuracy and consistency

Customer Service Foster strong internal and external relationships to support timely resolution of billing and reimbursement discrepancies

Communicate clearly, professionally, and collaboratively with payers, service line teams, leadership, and other stakeholders regarding claim status, reimbursement issues, and required follow-up

Serve as a resource for billing, reimbursement, and payment posting inquiries

Identify and recommend opportunities for process and policy improvement based on trends observed during claim follow-up and reimbursement activities, and partner with Revenue Cycle leadership on appropriate workflow improvements

Collaborate with the Revenue Cycle Management Team to support efficient systems, workflows, and standardized processes

Revenue Cycle Operations & Continuous Improvement Participate in cross-training initiatives across Revenue Cycle functions to strengthen team coverage, knowledge sharing, and operational consistency

Assist in the development and maintenance of workflow documentation, job aids, and standard operating procedures

Support continuous improvement and departmental standardization efforts that improve billing accuracy, reimbursement outcomes, and operational efficiency

Participate in special projects related to revenue cycle optimization and financial sustainability

Contribute to a culture of accountability, continuous learning, and teamwork

Quality Performance & Risk Management Maintain compliance with regulatory agencies governing Medicaid, Managed Care, and governmental billing practices, as well as organizational policies, governmental regulations, and fiscal management standards

Maintain strict confidentiality and sound ethical judgment when handling financial and client information, including compliance with HIPAA requirements related to billing and protected health information

Support audit requests and documentation reviews as assigned

Identify and report compliance concerns, payment irregularities, or process risks to leadership in a timely manner

Success Measures Claims are submitted, followed up on, corrected, appealed, and resolved within established departmental timeframes

Payment posting, adjustments, denials, refunds, and remittance activity are completed accurately and consistently

Accounts receivable worklists are maintained proactively, with appropriate prioritization based on aging, reimbursement risk, and leadership direction

Billing and reimbursement issues are documented clearly, escalated appropriately, and supported by timely communication with stakeholders

Compliance standards are consistently followed, including confidentiality, HIPAA, payer requirements, and audit support expectations

Individual Performance Scorecard goals, cross-training expectations, and Revenue Cycle team priorities are actively supported and achieved

Corporate Citizen Demonstrate ruthless pragmatism in problem solving and decision making.

Engage in constructive peer-to-peer feedback.

Know and live the Necco Corporate Culture Principles.

Embody the three essential virtues of humble, hungry, and smart.

Actively manage and drive Individual Performance Scorecard goals.

Participate in and contribute to Necco's meeting structure and organizational initiatives.

Take ownership of assigned responsibilities and work collaboratively to achieve team goals.

Bring solutions alongside identified challenges and opportunities.

Position Qualifications

Required High school diploma or GED required; degree or certificate in Medical Billing, Coding, Healthcare Administration, Business Administration, or a related field preferred

Minimum of three (3) years of healthcare billing, accounts receivable, payment posting, denial management, or revenue cycle experience

Experience with EHR and clearinghouse software; experience utilizing payer portals and electronic remittance systems preferred

Proficiency with Microsoft Office Suite and the ability to work accurately with complex electronic records, reports, and data sets

Experience with Medicaid, Managed Care Organizations (MCOs), governmental billing, or other payer requirements preferred

Strong communication and customer service skills, with the ability to work collaboratively with internal and external stakeholders

Ability to manage multiple priorities and deadlines while remaining self-directed, resourceful, detail-oriented, and adaptable

Experience working in behavioral health, social services, foster care, or community-based healthcare settings preferred

Successful completion of all required criminal background checks and willingness to complete required travel and training

Valid driver's license and state minimum auto insurance coverage

At Necco, we value diversity and are committed to creating an inclusive and equitable work environment. We embrace individuals of diverse backgrounds, experiences, and perspectives. We believe that a diverse team fosters innovation and creativity, and we actively seek candidates from all races, ethnicities, religions, genders, sexual orientations, abilities, and ages to join our organization. We are dedicated to providing equal opportunities for employment and advancement to all qualified individuals, and we encourage applicants of all backgrounds to apply.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Worksite address

cincinnati, OH, 45208, US

Who can apply

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