Department: Revenue Cycle Management (RCM) Reports To: Revenue Cycle Manager Employment Classification: Full-Time | Non-Exempt Location: Johnson City, TN (on-site)

Position Summary

The Revenue Cycle Billing Specialist is responsible for the accurate, timely, and compliant preparation, submission, and management of medical claims to insurance payers. This position plays a critical role in optimizing revenue cycle performance by ensuring services are appropriately documented, charges are accurately captured, claims are submitted promptly, and billing errors are proactively identified and resolved.

The ideal candidate demonstrates strong attention to detail, knowledge of medical billing practices, and a results-oriented approach to maximizing clean claim submissions while minimizing avoidable denials and reimbursement delays.

Essential Duties and Responsibilities

Claims Processing and Submission

· Review patient encounters to ensure charges are accurately captured and submitted.

· Verify patient demographics, insurance coverage, eligibility, and billing information.

· Review CPT, HCPCS, ICD-10-CM codes, modifiers, and applicable payer billing requirements for accuracy, escalating clinical coding questions as appropriate.

· Prepare and submit electronic and paper claims in accordance with established timelines.

· Monitor clearinghouse submissions, claim acknowledgments, and rejections.

· Correct and resubmit rejected claims promptly.

· Ensure timely filing requirements are consistently met.

Billing Accuracy and Quality Assurance

· Identify missing charges, incomplete documentation, coding discrepancies, and billing errors.

· Coordinate with providers, clinical personnel, and administrative teams to resolve documentation or charge entry issues.

· Monitor unbilled encounters and claims pending submission.

· Maintain awareness of Medicare, Medicaid, and commercial payer billing guidelines.

· Assist in identifying recurring billing issues and opportunities for process improvement.

Revenue Cycle Coordination

· Collaborate with collections specialists to resolve claim defects and prevent recurring denials.

· Support the development of standardized billing workflows and quality control processes.

· Maintain accurate documentation of billing activities and claim corrections.

· Escalate systemic billing issues or payer-related concerns to RCM leadership.

Required Qualifications

· High school diploma or equivalent required; associate degree preferred.

· Minimum 2 years of medical billing or physician-practice revenue cycle experience preferred.

· Working knowledge of CPT, ICD-10-CM, HCPCS, insurance billing requirements, and medical terminology.

· Experience with electronic health record and practice management systems; Athenahealth experience preferred.

· Familiarity with Medicare, Medicaid, and commercial insurance billing.

· Proficiency with Microsoft Excel and standard office applications.

· Strong organizational, analytical, and problem-solving skills.

Preferred Qualifications

· Certified Professional Biller (CPB) or Certified Professional Coder (CPC).

· Experience in a multispecialty or multi-location physician practice.

· Familiarity with clearinghouse workflows, payer portals, and claim-editing tools.

Performance Expectations

The Billing Specialist is expected to maintain consistent daily productivity, manage assigned billing queues, proactively resolve submission barriers, and ensure that claims are processed accurately and efficiently.

Success in this position is measured by the quality, timeliness, and completeness of billing activities and the reduction of preventable revenue cycle delays.

Benefits:

Medical, Dental, Vision, PTO, 401k, and Weekends off!

Department: Revenue Cycle Management (RCM) Reports To: Revenue Cycle Manager Employment Classification: Full-Time | Non-Exempt Location: Johnson City, TN (on-site)

Position Summary

The Revenue Cycle Collections Specialist is responsible for the proactive management, follow-up, and resolution of outstanding insurance accounts receivable to maximize reimbursement and minimize aging balances.

This position is accountable for researching unpaid, underpaid, and denied claims; engaging insurance payers to secure appropriate reimbursement; and resolving outstanding balances in a timely manner.

The ideal candidate demonstrates strong analytical skills, persistence, payer reimbursement knowledge, and a high degree of ownership over assigned accounts receivable.

Essential Duties and Responsibilities

Accounts Receivable Management

· Manage an assigned portfolio of insurance accounts receivable, prioritizing claims based on age, balance, payer, and reimbursement risk.

· Perform timely follow-up on unpaid, delayed, denied, and underpaid claims.

· Contact insurance payers through portals, telephone, and other approved communication channels to determine claim status and facilitate resolution.

· Investigate outstanding balances and identify root causes of payment delays.

· Resolve outstanding claims through appropriate follow-up, corrected claims, reconsiderations, appeals, or other authorized processes.

· Ensure claims are addressed before applicable timely filing and appeal deadlines.

· Maintain accurate account notes documenting actions, payer communications, and next steps.

Denial Management and Appeals

· Analyze claim denials to identify underlying causes and appropriate corrective actions.

· Prepare and submit appeals, reconsiderations, and supporting documentation.

· Identify patterns in payer denials, payment discrepancies, and reimbursement practices.

· Collaborate with billing specialists and clinical personnel to correct recurring claim issues.

· Escalate systemic payer issues, contractual disputes, and unresolved claims to RCM leadership.

Payment Integrity and Reimbursement

· Review insurance payments for accuracy against applicable contractual allowances and expected reimbursement.

· Identify and pursue underpayments and inappropriate claim adjustments.

· Research payment discrepancies, coordination-of-benefits issues, and outstanding payer obligations.

· Recommend account adjustments or write-offs when appropriate, subject to established authorization policies.

· Assist in reconciling outstanding claims and ensuring accurate A/R reporting.

A/R Aging and Performance Management

· Work assigned accounts consistently according to established aging and prioritization protocols.

· Focus on reducing balances aged beyond 60 and 90 days.

· Identify claims at risk of becoming uncollectible and escalate promptly.

· Maintain a documented follow-up plan for unresolved accounts.

· Provide feedback regarding payer trends, operational barriers, and opportunities to accelerate reimbursement.

· Participate in periodic A/R reviews and performance improvement initiatives.

Required Qualifications

· High school diploma or equivalent required; associate degree preferred.

· Minimum 2 years of medical insurance collections, accounts receivable, or denial management experience preferred.

· Strong understanding of Medicare, Medicaid, and commercial insurance reimbursement.

· Experience with claim status research, denial resolution, appeals, and payer follow-up.

· Working knowledge of CPT, ICD-10-CM, insurance terminology, and explanation of benefits (EOB) documentation.

· Proficiency with EHR/practice management systems, payer portals, and Microsoft Excel.

· Strong communication, negotiation, organizational, and problem-solving skills.

Preferred Qualifications

· Experience with Athenahealth or comparable practice management platforms.

· Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), or similar credential.

· Experience managing complex or aged insurance receivables.

· Familiarity with payer contracts, fee schedules, and reimbursement variance analysis.

· Experience in a multispecialty or multi-location physician practice.

Performance Expectations

The Collections Specialist is expected to demonstrate active ownership of assigned accounts receivable, maintain disciplined follow-up practices, and pursue timely and appropriate reimbursement.

Success in this position is measured by documented account activity, effective claim resolution, reimbursement recovery, reduction in aged receivables, and the prevention of avoidable revenue loss.

The specialist is expected to identify barriers proactively, escalate unresolved issues appropriately, and contribute to continuous improvement in revenue cycle performance. /c

Benefits:

Medical, Vision, Dental, PTO, 401K, and Weekends Off!

Employment Type: Part-Time – Monday-Friday 8:00 AM-5:00 PM (on-site and Telemedicine)

Qualifications:

·         Master’s degree in nursing

·         Active Nurse Practitioner (NP) license in the Commonwealth of Virginia

·         National Board Certification as a Family Nurse Practitioner (FNP) through AANP or AANC.

·         Active and unrestricted DEA license with buprenorphine/MAT prescribing authority (or willingness to obtain).

·         Experience delivering primary care services.

·         Experience in Medication-Assisted Treatment (MAT) or willingness to receive training.

·         Current CPR/BLS certification.

·         Ability to work independently and collaboratively within a multidisciplinary team.

·         Strong clinical, assessment, documentation, and communication skills.

·         Commitment to evidence-based practice and patient-centered care.

·         Excellent communication and interpersonal skills.

·         Ability to collaborate effectively with a multidisciplinary team.

·         Commitment to providing compassionate and patient-centered care.

·         Ability to effectively manage a high-volume workload in a dynamic and fast-paced clinical environment.

Key Responsibilities:

·         Conduct comprehensive assessments of patients with substance use disorder·         Develop and implement individualized treatment plans that include medication-assisted treatment

·         Prescribe and manage medications for substance use disorders in accordance with established protocols

·         Monitor patient progress, including medication adherence and response to treatment

·         Deliver comprehensive primary care services to patients, including preventive medicine and management of acute and chronic conditions

·         Educate and counsel patients on prevention strategies and treatment adherence

·         Collaborate with licensed counselors and support staff to ensure coordinated and integrated care

·         Maintain accurate and timely documentation in the electronic health record (EHR)

·         Remain up to date with best practices and guidelines in addiction medicine and primary care

·         Perform all duties in a professional and competent manner, utilizing clinical expertise and sound medical judgment in patient care.

·         Clinical decisions shall be made in accordance with the nurse practitioner's best medical judgment.

·         The Medical Director or Supervising Physician reserves the authority to designate patients for evaluation by the nurse practitioner.

·         Adhere to all established rules, regulations, policies, and procedures set forth by the Medical Director, ensuring compliance with organizational and regulatory standards.

-Assess patients under provider supervision using standardized rating scales and report abnormalities to care team promptly.  

-Organize, track and complete medical records requests, as ordered by the care team, while ensuring that all appropriate releases of information are on file and up to date. 

-Review CSMD/PMP prior to initial visit for all patients and periodically and/or as requested for follow-ups. Findings should be reported to the ordering provider. 

-Referrals/New Patients 

·         Ensure that psychiatry referrals are handled appropriately. All new referrals should complete new patient psychiatry paperwork. CMA will ensure all required information is complete and request records from previous providers or pharmacies, as necessary.  

·         A reasonable effort should be made to schedule referred patients within 2 weeks.  

·         Track all referrals to ensure that they are scheduled or rescheduled appropriately. 

·         Periodic review of patient roster to ensure that follow-up visits are scheduled. 

 -Labs/testing 

·         Labs for psychiatric patients completed and tracked per BPG. 

o    Enter into chart. 

o    Flag patients overdue for monitoring. 

o    Assist patients with instructions and lab orders. 

·         CMA will assist providers in processing orders, such as Gene sight, as appropriate. (i.e.-entering demographic information in portal) 

·         CMA will assist in preparation of pertinent clinical data /chart entry of forms etc. prior to scheduled visit for provider review. 

·         CMA will assist in securing prior authorization for psychiatric medications. 

·         CMA will routinely audit clinic samples and ensure timely and appropriate inventory. 

o    Should be audited monthly.  

Supervised by Regional Office Manager:

Benefits

• Medical
• Dental
• Vision
• PTO
• HSA
• 401K
• Weekends Off

Employment Type: Full-Time – Monday-Friday 8:00 AM-5:00 PM (on-site)

Qualifications:

·         Master’s degree in nursing

·         Active Nurse Practitioner (NP) license in the Commonwealth of Virginia

·         National Board Certification as a Family Nurse Practitioner (FNP) through AANP or AANC.

·         Active and unrestricted DEA license with buprenorphine/MAT prescribing authority (or willingness to obtain).

·         Experience delivering primary care services.

·         Experience in Medication-Assisted Treatment (MAT) or willingness to receive training.

·         Current CPR/BLS certification.

·         Ability to work independently and collaboratively within a multidisciplinary team.

·         Strong clinical, assessment, documentation, and communication skills.

·         Commitment to evidence-based practice and patient-centered care.

·         Excellent communication and interpersonal skills.

·         Ability to collaborate effectively with a multidisciplinary team.

·         Commitment to providing compassionate and patient-centered care.

·         Ability to effectively manage a high-volume workload in a dynamic and fast-paced clinical environment.

Key Responsibilities:

·         Conduct comprehensive assessments of patients with substance use disorder·         Develop and implement individualized treatment plans that include medication-assisted treatment

·         Prescribe and manage medications for substance use disorders in accordance with established protocols

·         Monitor patient progress, including medication adherence and response to treatment

·         Deliver comprehensive primary care services to patients, including preventive medicine and management of acute and chronic conditions

·         Educate and counsel patients on prevention strategies and treatment adherence

·         Collaborate with licensed counselors and support staff to ensure coordinated and integrated care

·         Maintain accurate and timely documentation in the electronic health record (EHR)

·         Remain up to date with best practices and guidelines in addiction medicine and primary care

·         Perform all duties in a professional and competent manner, utilizing clinical expertise and sound medical judgment in patient care.

·         Clinical decisions shall be made in accordance with the nurse practitioner's best medical judgment.

·         The Medical Director or Supervising Physician reserves the authority to designate patients for evaluation by the nurse practitioner.

·         Adhere to all established rules, regulations, policies, and procedures set forth by the Medical Director, ensuring compliance with organizational and regulatory standards.

Benefits:  

·         Medical Insurance

·         Dental Insurance

·         Vision Insurance

·         Paid Time Off

·         401K Matching