Position Title: Revenue Quality Specialist
Position Goals and Role:
This is a full time position at REACH Medical
REACH Medical provides low-threshold, harm reduction-oriented primary care in a multi-disciplinary, integrated practice to further the REACH Mission of ensuring health equity to all who typically face stigma in the current healthcare system.
Responsibilities:
Review revenue cycle workflows for accuracy and compliance
Conduct chart reviews across multiple clinical departments, including providers, nursing staff, and intake teams, to ensure documentation accuracy, billing integrity, and compliance with organizational standards
Collaborate with supervisors to support staff education and corrective action plans based on audit results
Manage the Office of Medicaid Inspector General (OMIG) overpayment process by identifying, investigating, analyzing, and validating potential overpaid claims in accordance with OMIG guidelines and regulatory requirements
Maintain accurate records of overpayment findings, corrective actions, and repayment activity to support audit readiness and regulatory compliance
Monitor claim rejections, appeals, and resubmissions
Ensure compliance with payer, regulatory, and organizational standards
Monitor quality metrics and recommend corrective actions and improvement opportunities
Develop, implement, and maintain revenue cycle policies, procedures, and standard operating procedures (SOPs) to support operational consistency
Translate complex audit findings into clear, concise presentations and reports
Communicate revenue cycle updates, compliance requirements, and regulatory changes to staff through training, guidance materials, and process documentation
Understand Office Of Addiction Services and Supports (OASAS) operations and regulatory requirements
Works closely with the Revenue Cycle Manager to monitor billing accuracy and regulatory compliance
Work collaboratively with Finance, Operations, Compliance, and other departments to improve reimbursement outcomes and accuracy
Operate in a manner that complies with all organizational, city, county, state, and federal guidelines
Attend designated meetings and keep accurate minutes/records when necessary
Serve as a resource to clinical and operational teams regarding documentation standards, revenue cycle quality expectations, and regulatory requirements
Ensure timely and accurate submission of reports and meet regulatory deadlines
Keep up with medicare, medicaid and OASAS changes in billing and understand how to change our billing to keep up with these changes
Other duties as assigned by the supervisor
Qualifications:
Advanced Excel skills and experience with the Excel Business Intelligence Tools
Extensive experience in healthcare revenue cycle operations, medical billing, and coding, with OASAS and working with organizations like CHP, and familiarity with Article 28 and FQHC billing
Extensive experience utilizing cloud based information systems
Undergraduate degree in a relatable field.
Strong organizational and collaborative skills
Understanding of data privacy laws and regulations (HIPAA, GDPR, etc.)
Preferred experience with Trizetto Medical Billing Clearinghouse
Supervision:
The position reports to the REACH Comptroller.
Benefits:
The position offers a competitive salary and benefits.
