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.

The REACH Project Inc. is a nonprofit organization with the belief that all individuals deserve respectful, equitable, access to compassionate healthcare in a setting where they will not be stigmatized or judged based on drug use, homelessness, or any other issue that may cause less than adequate care in today's healthcare environment.

The REACH Project owns and operates the first low threshold, harm reduction medical practice in Ithaca, NY