Revenue Cycle Specialist

Company Overview

Prism Healthcare is a dedicated behavioral agency that focuses on supporting individuals facing social, communication, and behavioral challenges. Our mission is to partner with families to create personalized therapeutic plans that empower children to thrive in their daily lives.

Summary

The Revenue Cycle Specialist is responsible for managing outstanding accounts receivable for ABA services by following up on unpaid claims, resolving billing discrepancies, and coordinating with payers, clients, and internal staff to ensure timely reimbursement. This role is essential to maintaining healthy cash flow and supporting the agency’s financial operations.

Responsibilities

* Review and follow up on **unpaid, denied, and underpaid claims** across all major insurance payers.

* Monitor **aging reports** and maintain clear documentation of collection activities.

* Initiate contact with insurance companies to resolve outstanding claims via phone, email, and payer portals.

* Work within billing platforms such as **Tebra**, **Rethink**, or clearinghouses to track claim status and payment trends.

* Submit appeals, reconsiderations, and corrected claims as needed.

* Track and document **denial reason codes**, resolution steps, and outcomes.

* Collaborate with billing and clinical teams to address coding, documentation, or authorization-related issues.

* Ensure patient/client confidentiality and HIPAA compliance at all times.

* Escalate unresolved or high-balance claims to Billing Supervisor or leadership team.

* Assist in month-end reporting, audits, and reconciliation efforts.

**Qualifications:**

* High school diploma or equivalent required; Associate’s or Bachelor’s degree in Business, Healthcare Administration, or related field preferred.

* **1–2 years of Billing Collection / collections experience in ABA or behavioral health preferred.

* Proficiency in billing software (Tebra, Kareo, Rethink, or similar).

* Strong understanding of **insurance claim processing**, **EOBs/ERAs**, and **denial codes**.

* Excellent communication, follow-up, and organizational skills.

* Bilingual (Spanish/English) .

**Performance Metrics:**

* Monthly collection goals

* Days in AR

* Denial resolution turnaround time

* Number of successful appeals or resubmissions

If you are passionate about making a difference in the lives of individuals and their families while contributing to the financial health of our organization, we invite you to apply for the Billing Collector position at Prism Healthcare today!

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have at least 1 year of experience in Accounts Receivable?

Language:

• Spanish (Required)

Work Location: In person