Position Overview
Empowerment Behavioral Therapeutic Services (EBTS) is seeking a detail-oriented and experienced Revenue Cycle Specialist to support our growing behavioral health operations. This role is responsible for managing the full revenue cycle, ensuring accurate billing, compliance with Maryland OMHC and PRP regulations, and optimizing reimbursement processes.
The ideal candidate will have strong experience in behavioral health billing, coding, and payer regulations, with a deep understanding of Maryland Medicaid requirements and documentation standards.
Key Responsibilities
Revenue Cycle Management
- Manage end-to-end revenue cycle processes including charge entry, claims submission, payment posting, and denial management
- Monitor claim status and ensure timely reimbursement
- Reconcile claims and identify trends impacting revenue performance
- Support tracking of authorizations, units, and service frequencies across programs (e.g., OMHC, PRP)
- Monitor service utilization trends and flag inconsistencies or risks related to authorizations, billing, and service delivery
Billing & Coding
- Accurately apply CPT/HCPCS codes and appropriate modifiers for OMHC and PRP services
- Ensure compliance with Maryland Medicaid billing guidelines and payer-specific requirements
- Review clinical documentation to support billing accuracy and regulatory compliance
- Represent EBTS in payer provider meetings
Denials & Collections
- Investigate and resolve denied or rejected claims
- Submit appeals and track outcomes
- Collaborate with clinical and administrative teams to prevent recurring issues
Reporting & Analysis
- Generate revenue cycle reports (AR aging, denial trends, collections)
- Provide insights and recommendations to improve financial performance
- Track key performance indicators (KPIs) related to billing and reimbursement
Collaboration
- Work closely with the CFO, billing team, and clinical staff
- Provide guidance on documentation and billing best practices
- Support system optimization
Minimum Qualifications
- 5+ years of experience in healthcare revenue cycle management (behavioral health preferred)
- Strong knowledge of Maryland OMHC and PRP regulations
- Experience with Medicaid and commercial insurance billing
- Proficiency in CPT, HCPCS, and ICD-10 coding
- Experience with EMR and billing systems
- Strong analytical, problem-solving, and organizational skills
- High attention to detail and accuracy
Preferred Qualifications
- Experience in outpatient mental health or PRP programs
- Familiarity with audit processes and compliance standards
- Advanced Excel or reporting skills
- Proficiency with Notenetic, Payspan, Availity, Zelis, and Carelon
- Certification in medical billing/coding (e.g., CPC, CCS)
Work Schedule
- Monday-Friday 8:30am-5:00pm