Remote Edi Jobs in Sun Prairie, WI (NOW HIRING)

LEARN Behavioral is a national organization made up of dedicated and caring individuals with the sole purpose of nurturing children with autism and special needs to lead resilient and fulfilling lives.  We specialize in contemporary, evidence based applied behavior analysis to deliver personalized treatment plans, backed by 20 years of clinical insights.  We are proud to be a part of each family's journey and share in the experience of finding success for every child, and family, in our care.  If you share a similar passion for nurturing and empowering the success of others, along with the opportunity to have an impact on the lives of others, we are eager to connect with you! 

The Revenue Cycle Management (RCM) Coordinator works under the guidance of the RCM Specialist/RCM Manager to support revenue cycle operations. The ideal candidate will demonstrate exceptional attention to detail, uphold the highest standards of customer service, possess outstanding written and verbal communication skills, and exhibit proficiency in revenue cycle management processes and practices.

This is a full-time remote opportunity. Open to candidates who reside in any time zone. Pay starting at $24/hr. 

• Manage the complete revenue cycle for assigned Wisconsin payors, including accurate claim submission, payment posting review, denial resolution, appeals, and follow-up to maximize reimbursement and reduce accounts receivable.
• Investigate and resolve claim denials, rejections, and payment discrepancies by working collaboratively with internal departments and payor representatives to identify root causes and implement corrective actions.
• Generate invoices for private payers, county payers, and state billing programs.
• Follow up on assigned outstanding aging reports to ensure prompt remittance.
• Monitor changes to Wisconsin Medicaid and commercial payor policies, fee schedules, and billing requirements, proactively communicating updates and recommending workflow improvements to maintain compliance and optimize reimbursement.
• Partner with Clinical Operations, Utilization Management, Credentialing, and other cross-functional teams to resolve billing issues, improve revenue cycle performance, and support timely, accurate reimbursement for ABA services.
• Support the maintenance and achievement of departmental KPIs.
• Prepare weekly accounts receivable (AR) reports covering claim submission, billing, follow-up, and analysis.
• Identify and communicate potential revenue risks and opportunities.
• Comply with all company billing policies, procedures, and regulatory compliance standards.
• Perform special projects and additional tasks as assigned.

• High School diploma or equivalent, college preferred
• A minimum of 3-5 years of experience in healthcare billing/accounts receivable/revenue cycle
• Experience in Forward Health in Wisconsin (i.e., Wisconsin Medicaid) preferred
• Proficient in CPT, ICD10, HCPCS coding, and Microsoft Suites (Excel, Word, and Outlook)

• Communicates well via written and verbal methods

• Customer/client relationship focused

• General knowledge of EDI reports

• Analytical with strong problem-solving abilities

• Ability to multi-task and maintain thoroughness

• Thrive in a fast-paced environment

• Adaptable to change

• Positive approach to daily routine

LEARN Behavioral offers competitive compensation, a comprehensive benefits plan, including 401(k), personal time off, paid holidays, and tuition reimbursement.

LEARN Behavioral is an Equal Opportunity Employer. Candidates must be presently eligible to work in the United States.