Accounts Receivable Specialist

Role Description

The Accounts Receivable Specialist is responsible for following up directly with commercial, governmental, and other payers to resolve claim payment issues, to secure appropriate and timely reimbursement and response. Identifies and analyzes denials, payment variances, and no response claims and acts to resolve claims/accounts, including drafting and submitting technical and clinical appeals. Provides support for all denial, no response, and audit activities.

• Examines denied and other non-paid claims to determine the reason for discrepancies.
• Communicates directly with payers to follow up on outstanding claims, files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement.
• Ability to identify specific reasons for underpayments, denials, and cause of payment delay. Works with management to identify, trend, and address root causes of issues in the A/R.
• Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly.
• Documents all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system.
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Needs to be a strong problem solver and critical thinker to resolve accounts.

Qualifications

• Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel.
• Excellent verbal skills.
• Problem solving skills, the ability to look at accounts and determine a plan of action for collection.
• Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment.
• Adaptability to changing procedures and growing environment.
• Meet quality and productivity standards within timelines set forth in policies.
• Meet required attendance policies.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Requirements

• 2 or 4-year college degree.
• 1 or more years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing preferred.
• Knowledge of claims review and analysis.
• Working knowledge of revenue cycle.
• Experience working the DDE Medicare system and using payer websites to investigate claim statuses.
• Working knowledge of medical terminology and/or insurance claim terminology.

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement