内部计费与收入周期专员
Internal Billing & Revenue Cycle Specialist
职位概述
一位心理健康客户正在寻找一位经验丰富、组织能力强、以患者为中心的内部计费与收入周期专员，负责管理该诊所的全流程收入周期，从头到尾。该职位负责完整的计费生命周期——费用捕获和入院登记、索赔提交、付款记录、拒付管理、应收账款跟进和患者收款，并作为患者和保险公司付款人的主要联系人。
这是一家行为健康诊所，行为健康计费知识是真正必备的：行为健康使用编码和付款人流程与普通医疗或家庭医学计费有本质区别，理想的候选人应已熟练掌握这些内容。诊所目前正新近进行Medicare认证（Medicare Advantage/商业认证正在进行中），尚未具备内部Medicare专业知识——此人必须能够从第一天起独立处理Medicare Part B索赔，无需依赖内部导师。
理想的候选人能够在计费运营的幕后工作，也能直接与患者和家属打交道，提供卓越、富有同理心的客户服务，并将与诊所经理和首席执行官（Bryant博士）密切合作，后者每周召开计费会议，并期望获得清晰、准确的报告。
主要职责和任务
收入周期（全流程，从前到后）
- 负责诊所的完整收入周期，包括前台和后台——费用录入、入院登记、索赔创建、索赔提交、付款记录和应收账款流程。
- 审核索赔的准确性，在提交前识别计费问题。
- 调查并解决索赔被拒、拒付和付款不足的情况；必要时提交更正后的索赔和申诉。
- 审核应收账款账龄报告，确保及时报销。
- 作为患者和保险付款人的主要联系人——不进行外部计费供应商交接。
患者计费与收款
- 根据诊所政策管理患者余额和收款活动。
- 就未结余额联系患者，并在适当情况下建立付款安排。
- 处理患者付款并保持准确、透明的账户余额——不隐藏费用或对上月计费进行追溯性修正。
- 核对付款差异并调查计费问题。
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Position Summary
A Mental Health client is seeking an experienced, highly organized, and patient-focused Internal Billing & Revenue Cycle Specialist to own the practice's full-cycle revenue cycle management, front to back. This role is responsible for the complete billing lifecycle — charge capture and check-in, claim submission, payment posting, denial management, AR follow-up, and patient collections — and serves as the primary point of contact for both patients and insurance payers.
This is a behavioral health practice, and behavioral health billing knowledge is a true must-have: behavioral health uses coding and payer processes that are materially different from general medical or family practice billing, and the ideal candidate is already fluent in them. The practice is also newly credentialing with Medicare (with Medicare Advantage/commercial credentialing underway) and does not yet have in-house Medicare expertise — this person must be able to work Medicare Part B claims independently from day one, without an internal mentor to lean on.
The ideal candidate is comfortable working both behind the scenes on billing operations and directly with patients and families to provide exceptional, compassionate customer service, and will collaborate closely with the Practice Manager and CEO (Dr. Bryant), who runs a weekly billing meeting and expects clear, accurate reporting.
Essential Duties and Responsibilities
Revenue Cycle (Full Cycle, Front to Back)
• Own the full revenue cycle for the practice, front and back office — charge entry, check-in, claim creation, claim submission, payment posting, and AR workflows.
• Review claims for accuracy and identify billing issues prior to submission.
• Investigate and resolve claim rejections, denials, and underpayments; submit corrected claims and appeals as necessary.
• Review and work accounts receivable aging reports to ensure timely reimbursement.
• Serve as the primary point of contact for both patients and insurance payers — no external billing vendor hand-off.
Patient Billing & Collections
• Manage patient balances and collection activities in accordance with practice policies.
• Contact patients regarding outstanding balances and establish payment arrangements when appropriate.
• Process patient payments and maintain accurate, transparent account balances — no undisclosed charges or retroactive corrections to prior months' billing.
• Reconcile payment discrepancies and research billing concerns.
• Maintain accurate financial documentation and patient account records.
Patient Financial Services & Customer Support
• Serve as the primary contact for the practice's billing phone line.
• Answer patient questions regarding deductibles, copayments, coinsurance, eligibility/benefits, outstanding balances, payment arrangements, and billing statements/charges.
• Provide patients with copies of billing statements, itemized receipts, and payment histories upon request.
• Explain billing information clearly, professionally, and compassionately to patients and families.
• Resolve patient billing concerns promptly and escalate complex issues when necessary.
• Exceptional phone etiquette and customer service are required — the practice has had prior issues with unprofessional patient interactions, and this is a key hiring priority.
Reporting & Performance Monitoring
• Monitor and report on key revenue cycle metrics to management, including Days in AR, AR Aging, Clean Claim Rate, Claim Creation/Submission Lag, Payment Posting Timeliness, and Patient Collection Performance.
• Prepare and present clear reports for the CEO's weekly billing meeting; strong working proficiency in Excel and PowerPoint is required to build these reports independently.
Compliance & Collaboration
• Maintain compliance with HIPAA, payer guidelines, and all applicable federal and state regulations. Candidate must hold a current HIPAA certification.
• Ensure billing documentation supports medical necessity and payer requirements.
• Collaborate effectively with the Practice Manager, administrative staff, and CEO to resolve billing-related concerns and improve operational processes.
Qualifications
2+ years medical billing / revenue cycle experience, with dedicated behavioral health billing experience — a hard requirement, not a preference
• Direct, hands-on Medicare billing experience, ideally Medicare Part B, and the ability to work claims independently with no internal mentor
• Current HIPAA certification
• Comprehensive knowledge of the full billing lifecycle: claims management, payment posting, denials, collections, and AR
• Strong understanding of behavioral health CPT coding, ICD-10 coding, insurance terminology, and payer guidelines
• Exceptional customer service and phone/communication skills; professional and compassionate with financial conversations
• Strong analytical, organizational, and problem-solving skills; comfortable owning the full cycle independently
• Working proficiency in Excel and PowerPoint, sufficient to build AR aging, clean claim rate, and denial trend reports
Extras
• Experience with eClinicalWorks (eCW) or a comparable EHR/EMR
• Experience with Medicaid billing
• Experience with EAP insurances, particularly Lyra and ComPsych (training provided if needed)
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