Revenue Cycle Specialist II – Appeals and Denials

Senior PsychCare; Houston (TX); On-site; USD 30,000 - 39,000; Full time

Benefits offered by this job

Paid Time Off

Paid Holidays

Health, Dental, Vision

401k

Disability & Life Insurance

Job summary

Senior PsychCare in Houston seeks a Revenue Cycle Specialist II to support the Billing Team. You will handle follow-ups on denied claims, ensure timely submission, and work with payers to resolve reimbursement issues. This is a full-time, on-site role with standard weekday hours.

Required: 3+ years in healthcare billing/denials, experience with government payors, CPT/HCPCS, and payer portals. Mental health exposure is a plus.

Qualifications

• Requires 3+ years in healthcare billing/denials, with focus on claims and EOBs.
• Government payor follow-up experience required (1+ year).
• Familiarity with CPT/HCPCS, Revenue Codes, modifiers, and diagnosis codes.

Responsibilities

• Manage ~70+ accounts daily to resolve claims.
• Leverage Medicare, Medicaid, LCDs knowledge for resolution.
• Review denied claims with documentation and file appeals.
• Call payers to identify reasons for denial and required corrections.
• Follow up with payers via phone, email, fax, or portals.
• Identify underpayments/overpayments and summarize findings.
• Prepare denied claim files and track reprocessing.
• Report trends and contract violations to Manager/Director.
• Engage insurers on recoupment and missing payments as needed.
• Update insurance information and support multi-layer billing.

Skills

Government payor follow-up

Independent work

Medical terminology

CPT/HCPCS codes

Revenue codes/modifiers/diagnosis

Payer portal & clearinghouse

Mental health experience

Job description

Description

Senior PsychCare has an immediate opportunity for a Revenue Cycle Specialist II to support our Billing Team in Houston.

ABOUT US:

Senior Psych Care provides fully integrative behavioral health services to the long-term care patient, at their facility. Services include individual, family, and group therapies, along with diagnostic evaluation and collaborative intervention between the therapy team and the psychiatric team.

Job Description

Revenue Cycle Specialist II is responsible for processing follow-up actions on claims denied for eligibility-related reasons and responding to health plan correspondence. In this role, you would identify billing issues affecting the provider’s claims and take necessary action to ensure timely and appropriate claim filing. In addition, perform follow-up activities and identifies reimbursement issues affecting these claims. The Revenue Cycle Specialist also takes necessary actions to insure accurate reimbursement and account resolution.

Responsibilities :

• Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher per day to ensure claim(s) resolution.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Review and attach appropriate documentation to resolve denied claims and submit appeals.
• Call payers to determine the true reason for denial and inquire on what corrections need to be made.
• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or payer portals.
• Review underpayments and overpayments, work with management to prepare spreadsheet and summarize findings; elevate as appropriate.
• Prepare and submit denied claims targeted project files to payers, track reprocessing of project files.
• Identify problematic claim trends and contract violations and report findings to the Manager and Director.
• Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.
• Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.
• Perform other duties assigned by Revenue Cycle Manger.

This is a full-time, in-person opportunity. Our work week is from Monday-Friday 8am-5pm (NO WEEKENDS Required).

Qualifications-Required Experience: 3+ years of recent Healthcare experience, specifically in a claims, Denials, billing, EOB and insurance verification.

• Minimum 1+ years’ experience in Government Payor follow- up (Required)
• Ability to work independently and prioritize monthly workflow (Required)
• Knowledge of Medical Terminology, CPT Codes, HCPCS, Revenue Codes, Modifiers and Diagnosis Codes (Required)
• Payer portal and clearinghouse experience (Required)
• Ability to work independently and prioritize monthly workflow (Required)
• Mental Health experience (Preferred)

What we offer:

• Paid Time Off and Paid Holidays
• Comprehensive benefits packages including Medical, Dental, Vision, 401k, Long Term and Short-Term Disability, Life Insurance
• Healthcare coverage available 1st day of the month following full-time employment.