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. Hybrid Role.