Accounts Receivable Specialist
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Job Description
Accounts Receivable Specialist responsible for end-to-end A/R management and claim resolutions. Working remotely to improve billing processes and enhance reimbursements.
Responsibilities:
- Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals.
- Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution.
- Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers.
- Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable.
- Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions.
- Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines.
- Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements.
- Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers.
- Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues.
- Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts.
- Build strong relationships with payer representatives to improve overall reimbursement efficiency.
- Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines.
- Review and resolve EDI rejections, claim edits, and submission errors.
- Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity.
- Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.
Requirements:
- High school diploma or GED.
- Minimum 1 year of medical billing, claims, or A/R experience.
- Advanced Microsoft Excel skills (vlookups, pivot tables, data organization).
- Strong analytical, investigative, and problem-solving skills.
- Excellent verbal and written communication skills.
- Demonstrated ability to work independently, meet deadlines, and achieve productivity goals.
- Basic understanding of insurance plans, medical terminology, Medicare and Medicaid billing guidelines.
Benefits:
- Comfortable working in a remote environment using virtual communication and collaboration tools
- Commitment to accuracy, efficiency, and continuous improvement in revenue cycle operations
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