Revenue Cycle Specialist

Revenue Cycle Specialist

Job Overview

Location/Schedule: This position is located at the Lloyd Corporate Plaza located in NE Portland, OR. The schedule for this position is Monday through Friday, 8:30 a.m. to 5:00 p.m.

Position: Revenue Cycle Specialist

Program: Finance

Cascadia’s Mission and Vision:

Mission: Cascadia Health delivers whole health care – integrated mental health and addiction services, primary care, and housing – to promote hope and support the well-being of the communities we serve. 

Vision: We envision a community where everyone benefits from whole health care, experiences well-being, and has a self-directed, connected life. 

Position Description: The Revenue Cycle Specialist is responsible for managing the Residential and Personal Care Service billing process including, ensuring all care provided is accurately logged, mapped to compliant codes, and submitted cleanly to payors.  This position is also responsible for working with the contracted revenue cycle company by responding to requests for information directly as well as coordinating requests made that involve other staff throughout Cascadia.

The job incumbent must understand, appreciate, and respect the differences within our Cascadia community. As such, it is expected that this position promotes integrated care, our vision of trauma-informed and person-first approaches and helps create a work environment of acceptance.

Essential responsibilities

This position description is not intended to be an all-inclusive list of responsibilities, skills, or working conditions associated with the position.  Management reserves the right to modify, add or remove duties as necessary. 

Claims Processing, Billing & Document Review

• Assemble, validate, and electronically submit Medicaid and commercial insurance claims through billing systems.
• Submit claims in accordance with payer requirements, company policies, and system guidelines.
• Review and post services, payments, adjustments, and other billing transactions accurately.
• Maintain supporting documentation for all claims, including service dates, delivery hours, and applicable billing codes.
• Process patient payments received by phone and apply accurately to accounts.
• Audit Electronic Visit Verification (EVV) logs against care plans daily to resolve missing timestamps, location exceptions, and provider discrepancies before claim submission.
• Review clinical charts to ensure HCPCS/PCS procedure codes and modifiers align with authorized services and medical limits.
• Verify that provider identity, client location, service date, service type, and clock-in/clock-out times accurately support billed services.
• Ensure all billed PCS tasks align with the client's authorized Plan of Care (POC).
• Utilize EMR software to conduct chart reviews and support billing accuracy.

Claims Resolution & Revenue Recovery

• Investigate denied or rejected claims, coordinate corrective actions with clinical staff, and submit timely appeals to recover revenue.
• Resolve claim rejections, duplicate charges, coding errors, and other billing discrepancies.
• Coordinate with third-party billing vendors to address claim and payment issues.

Accounts Receivable & Reporting

• Monitor aging accounts, track payments, post remittances, and prepare weekly and monthly billing reports.
• Reconcile processed data against system-generated reports to ensure accuracy and completeness.
• Record and apply Household Assessments and Sliding Fee Adjustments accurately, including retroactive updates when applicable.

Systems & Records Management

• Maintain system integrity by updating records as new information becomes available.
• Operate scheduling and registration systems proficiently to support billing and administrative processes.
• Scan, archive, and maintain records in accordance with documentation requirements.
• Accurately record client and staff errors per client policies.
• Record patient payment plans Post Electronic Remittance Advices per system instructions and balance to system reports.
• Continuously work the A/R in accordance with client policies

Customer Service & Communication

• Assist clients and patients by addressing billing-related questions and concerns.
• Liaison with contracted revenue cycle company to ensure a streamlined process that supports billing efficiencies.
• Coordinate with internal stakeholders and partner with contracted revenue cycle company to ensure requests of information are responded to and resolved.  
• Respond to phone inquiries professionally, resolving issues promptly and efficiently.
• Other tasks and duties as requested

Regulatory & Compliance

• Comply with and implement regulations, policies, and procedures under which the department and program operate.
• Assist in crisis situations as appropriate, following emergency protocols and procedures.  
• Understand fire regulations and evacuation procedures; participate in regular safety drills in compliance with department policies and procedures.

• Document and maintain records in a manner that ensures compliance with all agency policies and procedures and local, state, and federal regulations. 

• Adhere to mandatory abuse reporting laws, HIPAA and 42CFR regulations requirements.

• Complete annual employee training requirements on a timely basis.
• Participate in all scheduled staff meetings, supervision sessions, and other departmental and agency meetings.

Qualifications

Education:

Required:

• High School diploma or GED required

Preferred:

• Associate or bachelor’s degree in healthcare administration, accounting or finance.

Experience:

Required:

• Minimum two years of dedicated experience in a healthcare medical billing environment.

Preferred:

• Direct exposure to Medicaid and Home and Community-Based Services frameworks.

Specialized Knowledge, Skills, and Abilities:

• Effective communication and active listening skills.
• Demonstrated effective interpersonal and customer service skills.
• Strong numerical and analytical skills.
• Strong problem-solving skills and ability to resolve billing issues.
• Ability to demonstrate professionalism, reliability, and initiative in daily work activities
• Knowledge of professional standards, ethical conduct, and accountability expectations in a healthcare environment.
• Knowledge of Electronic Health Records and State Medicaid portals.
• Ability to work proactively and effectively in a team as well as independently.
• Operate computer hardware and software at a level needed to effectively perform job functions.

Other:

• Must have the ability to perform CPR and properly use AED equipment. BLS certification training will be provided within the first 60 days of hire for client-facing staff, and CPR certification training will be provided within 120 days for all other staff. Certification must remain current.

Working Conditions: Work is performed in an administrative environment.  There is regular exposure to the elements and moderate physical and environmental demands associated with this position.  The work involves addressing new and unusual circumstances, requiring flexibility in time management and exercising sound judgement.

Cascadia is an Equal Opportunity employer.  If you need assistance or an accommodation due to a disability, you may contact us at 503.963.7654 or at [email protected]

Benefits

We offer generous benefits for our full-time and part-time employees (20 hours + pro-rated) including:

• Generous Paid Time Off Package - Full-time employees earn 6 weeks of PTO in their first year!
• Medical and Dental Coverage (begins 1st of the month following hire date)
• VSP Vision Discount Plan
• 403(b) Retirement Plan - Eligible after 60 days with immediate 100% vesting and a 1-to-1 company match up to 3% per pay period, plus the opportunity for an additional discretionary contribution (up to 5%) at the end of the fiscal year.
• Flexible Spending Account (FSA) (Medical, dependent care, and transportation options)
• Short-Term Disability, Long-Term Disability, and Life Insurance
• Paid Bereavement and Jury Duty Leave
• Length of Service Award
• Voluntary Life Insurance
• Supplemental Insurance
• Student loan forgiveness options

Wellness Benefits:

• Employee Assistance Program (EAP)
• Bike to Work Reimbursement
• Discounted Fitness Memberships
• Trauma Support Team

Starting Rate Range in USD ($)

$24.72 - $25.84