REVENUE CYCLE SUPERVISOR
Posted
Description
The Revenue Cycle Supervisor is responsible for performing hands-on revenue cycle work while overseeing the day-to-day activities, quality, and productivity of assigned billing and collections staff. This role manages claims submission, denial resolution, payer follow-up, payment posting, authorization reconciliation, and accounts receivable priorities while serving as a working resource for the team. The supervisor is accountable for improving cash collections, reducing Days Sales Outstanding (DSO), minimizing preventable denials, and ensuring accurate and timely reimbursement for services rendered.
The ideal candidate combines strong ABA or healthcare billing expertise with practical leadership skills. This individual is expected to work claims and account balances directly, troubleshoot complex issues, coach team members, monitor performance, and coordinate with clinical, intake, scheduling, operations, and finance teams to resolve barriers to reimbursement.
Reporting Relationship
• Department: Revenue Cycle Management (RCM) / Finance
• Reports To: VP of Finance
• Supervisory Scope: Provides day-to-day guidance and oversight to assigned billing, claims, and collections staff, while maintaining an individual workload of operational accounts and claims.
• Department: Revenue Cycle Management (RCM) / Finance
• Reports To: VP of Finance
• Supervisory Scope: Provides day-to-day guidance and oversight to assigned billing, claims, and collections staff, while maintaining an individual workload of operational accounts and claims.
Hands-On Revenue Cycle Operations
• Personally manage a portfolio of claims, payer accounts, denials, and aged receivables while maintaining consistent follow-up through resolution.
• Monitor the full claims lifecycle, including claim preparation, electronic submission, clearinghouse acceptance, payer adjudication, payment, and resolution of outstanding balances.
• Review claims for completeness and accuracy, investigate rejections or processing errors, and ensure corrections and resubmissions are completed within payer filing limits.
• Use practice management and billing platforms such as CentralReach, AlohaABA, or comparable systems to research claims, document actions, and track results.
• Post or oversee accurate posting of electronic remittance advice (ERA) and explanation of benefits (EOB) information, payments, adjustments, and approved write-offs.
Team Supervision and Workload Management
• Assign and balance daily work queues, payer follow-ups, denial cases, and aging accounts to ensure timely action and clear ownership.
• Monitor staff productivity, work quality, follow-up timeliness, documentation, and resolution rates; provide direct coaching and corrective guidance as needed.
• Serve as the first point of escalation for complex claim issues, payer disputes, billing questions, and workflow barriers.
• Train team members on billing procedures, payer requirements, system workflows, documentation standards, and effective denial-resolution practices.
• Review completed work for accuracy and consistency, reinforce accountability, and communicate priorities and performance expectations.
• Lead brief team huddles or workflow reviews to address backlogs, urgent filing deadlines, high-dollar claims, and recurring issues.
Denial Management and Appeals
• Investigate and resolve denied, rejected, or underpaid claims, including issues involving modifiers, coordination of benefits, eligibility, provider credentialing, authorizations, and documentation.
• Prepare, submit, and track appeals and corrected claims within required payer deadlines.
• Analyze denial patterns and perform root-cause reviews; implement corrective actions and share recurring trends with the RCM Manager and relevant departments.
• Ensure denial notes, payer communications, corrective actions, and appeal outcomes are documented accurately.
Authorization and Service Reconciliation
• Reconcile services rendered against active authorizations, approved units or hours, provider credentials, and applicable billing requirements.
• Monitor authorization utilization and expiration dates, identifying potential unbillable services and escalating discrepancies promptly.
• Partner with clinical, scheduling, intake, and operations teams to resolve authorization gaps, service mismatches, and other barriers to billing.
• Maintain working knowledge of applicable ABA CPT codes, including 97151–97158, and research payer-specific coding, modifier, documentation, and medical necessity requirements.
Accounts Receivable, Collections, and Cash Flow
• Prioritize follow-up based on aging, balance, filing deadlines, and likelihood of recovery, with particular attention to high-value and time-sensitive accounts.
• Conduct payer follow-up with commercial insurers, Medicaid plans, and regional center or other applicable funding networks for unpaid and aged balances.
• Reconcile payments, contractual adjustments, approved write-offs, and outstanding balances; investigate underpayments and payment discrepancies.
• Support appropriate patient and family billing, including copayments, coinsurance, deductibles, payment arrangements, and account inquiries, in accordance with company policy.
• Identify collection risks and promptly escalate material reimbursement delays, payer trends, and accounts requiring leadership intervention.
Reporting, Quality Control, and Process Improvement
• Prepare and maintain reports on clean claim rates, denial rates, collections, work queue status, and accounts receivable aging, including 30-, 60-, 90-day, and older balances.
• Monitor team and individual performance against established productivity, quality, timeliness, and collection goals.
• Provide updates on cash collection forecasts, unresolved payer issues, backlogs, and material reimbursement risks to the RCM Manager or finance leadership.
• Identify opportunities to improve claim accuracy, reduce avoidable denials, shorten resolution times, and strengthen revenue cycle workflows.
• Help standardize procedures, checklists, and documentation practices to improve consistency, training, and operational control.
Compliance and Confidentiality
• Ensure personal work and team activities follow HIPAA, applicable privacy requirements, payer rules, billing guidelines, and company policies.
• Maintain complete, accurate, and confidential billing records and supporting documentation.
• Escalate suspected billing inaccuracies, authorization gaps, compliance concerns, or other high-risk issues to the appropriate leader.
• Promote consistent adherence to established procedures for claim submission, appeals, adjustments, payment posting, and recordkeeping.
• Personally manage a portfolio of claims, payer accounts, denials, and aged receivables while maintaining consistent follow-up through resolution.
• Monitor the full claims lifecycle, including claim preparation, electronic submission, clearinghouse acceptance, payer adjudication, payment, and resolution of outstanding balances.
• Review claims for completeness and accuracy, investigate rejections or processing errors, and ensure corrections and resubmissions are completed within payer filing limits.
• Use practice management and billing platforms such as CentralReach, AlohaABA, or comparable systems to research claims, document actions, and track results.
• Post or oversee accurate posting of electronic remittance advice (ERA) and explanation of benefits (EOB) information, payments, adjustments, and approved write-offs.
Team Supervision and Workload Management
• Assign and balance daily work queues, payer follow-ups, denial cases, and aging accounts to ensure timely action and clear ownership.
• Monitor staff productivity, work quality, follow-up timeliness, documentation, and resolution rates; provide direct coaching and corrective guidance as needed.
• Serve as the first point of escalation for complex claim issues, payer disputes, billing questions, and workflow barriers.
• Train team members on billing procedures, payer requirements, system workflows, documentation standards, and effective denial-resolution practices.
• Review completed work for accuracy and consistency, reinforce accountability, and communicate priorities and performance expectations.
• Lead brief team huddles or workflow reviews to address backlogs, urgent filing deadlines, high-dollar claims, and recurring issues.
Denial Management and Appeals
• Investigate and resolve denied, rejected, or underpaid claims, including issues involving modifiers, coordination of benefits, eligibility, provider credentialing, authorizations, and documentation.
• Prepare, submit, and track appeals and corrected claims within required payer deadlines.
• Analyze denial patterns and perform root-cause reviews; implement corrective actions and share recurring trends with the RCM Manager and relevant departments.
• Ensure denial notes, payer communications, corrective actions, and appeal outcomes are documented accurately.
Authorization and Service Reconciliation
• Reconcile services rendered against active authorizations, approved units or hours, provider credentials, and applicable billing requirements.
• Monitor authorization utilization and expiration dates, identifying potential unbillable services and escalating discrepancies promptly.
• Partner with clinical, scheduling, intake, and operations teams to resolve authorization gaps, service mismatches, and other barriers to billing.
• Maintain working knowledge of applicable ABA CPT codes, including 97151–97158, and research payer-specific coding, modifier, documentation, and medical necessity requirements.
Accounts Receivable, Collections, and Cash Flow
• Prioritize follow-up based on aging, balance, filing deadlines, and likelihood of recovery, with particular attention to high-value and time-sensitive accounts.
• Conduct payer follow-up with commercial insurers, Medicaid plans, and regional center or other applicable funding networks for unpaid and aged balances.
• Reconcile payments, contractual adjustments, approved write-offs, and outstanding balances; investigate underpayments and payment discrepancies.
• Support appropriate patient and family billing, including copayments, coinsurance, deductibles, payment arrangements, and account inquiries, in accordance with company policy.
• Identify collection risks and promptly escalate material reimbursement delays, payer trends, and accounts requiring leadership intervention.
Reporting, Quality Control, and Process Improvement
• Prepare and maintain reports on clean claim rates, denial rates, collections, work queue status, and accounts receivable aging, including 30-, 60-, 90-day, and older balances.
• Monitor team and individual performance against established productivity, quality, timeliness, and collection goals.
• Provide updates on cash collection forecasts, unresolved payer issues, backlogs, and material reimbursement risks to the RCM Manager or finance leadership.
• Identify opportunities to improve claim accuracy, reduce avoidable denials, shorten resolution times, and strengthen revenue cycle workflows.
• Help standardize procedures, checklists, and documentation practices to improve consistency, training, and operational control.
Compliance and Confidentiality
• Ensure personal work and team activities follow HIPAA, applicable privacy requirements, payer rules, billing guidelines, and company policies.
• Maintain complete, accurate, and confidential billing records and supporting documentation.
• Escalate suspected billing inaccuracies, authorization gaps, compliance concerns, or other high-risk issues to the appropriate leader.
• Promote consistent adherence to established procedures for claim submission, appeals, adjustments, payment posting, and recordkeeping.