Revenue Cycle Specialist

POSITION SUMMARY 

All Together Recovery LLC (ATR), provides multiple levels of ASAM SUD/BHSO care, including recovery housing, education, job training, employment, and other recovery related extensions to the family in for-profit and non-profit environments. The Revenue Cycle Specialist is responsible for managing and optimizing the full revenue cycle process to ensure accurate, timely reimbursement for services rendered. This role supports financial stability by coordinating insurance verification, authorizations, billing, claims submission, payment posting, and follow-up on unpaid or underpaid claims. The Revenue Cycle Specialist works collaboratively with clinical, billing, and administrative teams to reduce denials, improve cash flow, and maintain compliance with payer and regulatory requirements. 

KEY PERFORMANCE INDICATORS (KPIs) 

Billing & Claims Management 

• Prepare and submit initial claims to insurance payers 

• KPI: 100% of claims submitted within 24 hours 

• Follow up on outstanding, denied, or rejected claims 

• KPI: 100% of denied and rejected claims resubmitted within 48 hours 

• KPI: 100% of claims worked within daily productivity  

• Process adjustments, re-bills, and corrections as needed 

• KPI: <98% of claims reconciled with insurance payments  

• Maintain organized records of all billed and pending claims 

• KPI: <98% of claims in the correct payer status  

Payment Posting & Reconciliation 

• Accurately post payments, adjustments, and remittances 

• KPI: 100% of EOB/ERAs posted accurately 

• Research and resolve payment discrepancies, underpayments, and overpayments 

• KPI: <98% of payment issues resolved accurately 

• Reconcile daily, weekly, and monthly billing reports to ensure accuracy 

• KPI: 100% of billing reports submitted to Business Office Manager 

Authorization & Utilization Management 

• Obtain initial insurance authorizations for assigned levels of care (e.g., 3.1 & 3.5 residential, PHP, IOP, outpatient) by submitting authorization requests to Medicaid and commercial payers via portals, fax, or phone. 

• KPI: 100% of initial authorization requests submitted within 24-48 hours of admission.  

• Track authorization start/end dates, approved days, and service limitations. 

• KPI: 100% of authorizations added to the Billing/Authorizations calendar daily.  

• Communicate authorization determinations, extensions, and denials to clinical, medical, and billing teams.  

• KPI: 100% of determinations communicated interdepartmentally via email daily.  

• Coordinate with clinical and medical staff to gather required documentation for concurrent reviews. 

• KPI: Send reminder emails to teams within 48 hours with 100% accuracy.  

• Monitor census and authorization expirations to prevent lapses in coverage. 

• KPI: 100% of determination dates added to the Authorization/Census Tracker.  

• Maintain accurate authorization records in the EHR and payer portals. 

• KPI: 100% of authorization determinations added to the EHR daily.  

• Follow up on pending authorizations and escalate urgent cases affecting patient care to the Business Office Manager. 

• KPI: 100% of pending authorizations followed up if needed.  

• Escalation effectiveness: Urgent authorization issues escalated same business day when impacting patient care. 

• Assist with appeals and retro-authorizations related to authorization denials. 

• KPI: 100% of appeals and retro-authorizations submitted within 5 days of determination.  

• Authorization-related denial rate: ≤ 5%. 

• Appeal success rate: ≥ 75% for appealed authorization denials. 

• Ensure compliance with payer guidelines, state regulations, and internal policies. 

• KPI: 100% compliance with payer guidelines and internal policies. 

• Scan, upload, and organize authorization correspondence and payer communications. 

• KPI: 100% of all authorization documentation uploaded and in patient charts. 

Administrative & Miscellaneous  

• Scan, organize, and maintain digital and physical correspondence including EOBs, denials, approvals, and payer letters 

• KPI: 100% of correspondence sorted  

• Prepare and mail invoices and other correspondence to patients and guarantors  

• KPI: 100% of invoices mailed monthly 

• Assist with answering incoming phone calls and direct to appropriate departments 

• KPI: 100% of phone calls answered 


• Assist with other duties as assigned by Business Office Manager 

BACKGROUND/EDUCATION: 

• The applicant must have a minimum of a high school diploma or GED.  

• Minimum of 2-3 years’ experience working in billing, revenue cycle, or another related field preferred. An associate degree is preferred but not required.  


• Experience working in behavioral health field strongly preferred. 


• Previous experience working with KIPU, CollabMD, Availity, KYMMIS, and other provider portals strongly preferred.