Revenue Quality Specialist

## Description

**Position Title:** RevenueQuality 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

**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.