MEDICAL ACCOUNTS RECEIVABLE SPECIALIST

Job Description

Job Description

Description:

Job Title

Accounts Receivable Specialist

Department

Revenue Cycle

Reports to

Accounts Receivable Supervisor

Status

Full-Time Non-Exempt

Accounts Receivable Specialist Position Summary

The Accounts Receivable Specialist is responsible for managing insurance claim follow-up and reimbursement activities to ensure timely and accurate payment from insurance carriers. This role oversees denial and aged claim inventories, submits and follows up on appeals and grievances, resolves payer-related issues, and maintains effective communication with patients, insurance representatives, and internal teams. The specialist also analyzes payer trends, manages claim adjustments and insurance correspondence, verifies patient eligibility when needed, and supports revenue cycle operations while maintaining HIPAA compliance.

Successful candidates possess a strong understanding of healthcare billing, insurance contracts, claims processing, and reimbursement guidelines. They demonstrate excellent problem-solving, organizational, and communication skills, along with proficiency in Microsoft Office applications and revenue cycle systems. The ideal candidate can work independently in a fast-paced environment, effectively interpret insurance explanations of benefits (EOBs), maintain confidentiality, and foster professional relationships with payers, physicians, and colleagues while supporting departmental performance goals and SMIL's commitment to excellence.

Accounts Receivable Specialist Detailed Responsibilities

• Manage denial inventory for all assigned payer plans.
• Managed aged claim inventory for all assigned payer plans.
• Responsible for keeping management informed of payer trends and issues resulting in delay of reimbursements.
• Timely submission and follow-up of appeals and grievances.
• Respond to patient and insurance inquiries in a timely manner and update accounts as necessary.
• Manage payer issue projects and bulk appeals.
• Identify, document, and perform claim adjustments.
• Manage insurance correspondence.
• Verify patient eligibility as necessary.
• Participates in on-going training for compliance, payer information, and insurance benefits to augment knowledge of procedures, regulations, and products.
• Comply with performance standards and departmental goals.
• Assist with overflow calls for PFS as needed.
• Maintains HIPAA compliance.
• Uphold all SMIL policies and procedures.
• Other duties as deemed necessary.

Accounts Receivable Specialist Specific Job Knowledge, Skill, and Ability

• Working knowledge of assigned healthcare contracts and billing requirements with a clear understanding of the plans’ guidelines, pre-certification requirements, and procedures for filing and appealing claims.
• Creative problem-solving abilities.
• Demonstrated efficiency with computerized spreadsheets and other Microsoft Office applications.
• Ability to communicate effectively both orally and in writing to establish and maintain effective working relationships with payers, referring physicians, management, and associates.
• Ability to accurately interpret insurance explanation of benefits.
• Excellent organizational and time management skills.
• Strong working knowledge of system applications, equipment, and workflow processes encompassing all areas of the revenue cycle.
• Ability to work in fast paced environment with a high aptitude for learning.
• Ability to work with minimal supervision.
• Must be able to communicate calmly, compassionately, and professionally with payer representatives and other outside contacts.
• The demonstration of ethical and professional conduct, including the ability to maintain confidentiality (HIPAA).

Among the many benefits of a career with Southwest Medical Imaging, are the following:

• Medical, Dental & Vision Coverage
• Health Savings Accounts (HSA-available if enrolled in a high-deductible plan)
• Flexible Spending Accounts (FSA)
• Dependent Care Reimbursement Accounts (DCRA)
• Employee Assistance Program (EAP available if enrolled in Health plan)
• 401(k) retirement plan
• Paid Time Off (PTO)
• Company Paid Basic Life & AD&D Insurance
• Voluntary Life Insurance
• Voluntary Short Disability
• Company Paid Long-Term Disability
• Pet Discount Program
• 6 paid Company Holidays
• Floating Holiday, Jury Duty & Bereavement Leave
• Tuition Reimbursement
• Competitive Salary
• Leadership Mentoring Opportunities

Qualifications

• High School Education or General Education Degree (GED) required.
• Minimum 1 year of experience in medical accounts receivable preferred.

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk and hear. Specific vision abilities required by this job include close vision, color vision, ability to adjust focus. The employee is frequently required to sit and must be able to remain in a stationary position while performing the essential duties of this position. Inside general air-conditioned, nonhazardous environment only with light background noise.