- Professional
- Ufficio in San Diego
At TURN our mission is Improving Lives. Our organization embraces the tenets of client-centered care, and our core values People, Culture and Growth are at the forefront of everything we do. We hire exceptional individuals seeking meaningful opportunities in a purpose-driven environment.
Position Summary
We are seeking a highly skilled and certified Revenue Cycle Specialist to lead and optimize our billing operations across Medicaid, commercial and Medicare services. This strategic role is responsible for analyzing complex claims data, ensuring regulatory compliance, and driving revenue cycle performance across the organization. The ideal candidate is a proactive problem solver with deep expertise in healthcare billing, payer relations, and financial reporting.
Key Responsibilities
Billing Operations Leadership
- Oversee comprehensive billing processes for Medicare, Medicaid, and commercial insurance payers.
- Design and implement billing protocols that align with organizational objectives and regulatory compliance standards.
- Continuously monitor and refine workflows to ensure operational excellence and revenue integrity.
Claims Management & Reconciliation
- Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements.
- Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement.
- Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation.
Revenue Optimization & Data Analysis
- Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement.
- Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting.
- Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals.
Regulatory Compliance
- Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations.
- Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.
Systems Management & Technology Optimization
- Evaluate, implement, and manage billing technologies and EHR platforms to enhance efficiency, scalability, and accuracy.
- Lead system upgrades and integrations to support evolving business needs and regulatory changes.
Team Leadership & External Representation
- Provide mentorship, training, and performance oversight to billing staff across multiple programs.
- Represent the organization at external billing and revenue cycle forums, fostering industry relationships and knowledge exchange.
Qualifications
- Certified Medical Billing Professional (e.g., CMRS, CPB, or equivalent).
- Associate’s or bachelor’s degree in business administration, Health Information Management, Accounting, or a related field (preferred).
- Minimum 5 years of progressive experience in healthcare billing and revenue cycle management.
- Advanced proficiency in Microsoft Office Suite, EHR platforms, and billing software systems.
- Strong analytical capabilities with a proven ability to translate complex data into strategic insights.
- Exceptional communication, leadership, and problem-solving skills.
- Demonstrated ability to thrive both independently and collaboratively in a fast-paced, compliance-driven environment.
MHS is committed to Equal Opportunity Employment and to attracting and retaining the most qualified employees without regard to race, color, national origin, religion, sexual orientation, gender, age, disability or protected veteran status.
