Accounts Receivable (A/R) Specialist
Regional Medical Management Services LLC
Job Description
Job Description
Position Summary
RMMS is seeking a detail-oriented Accounts Receivable (A/R) Specialist to join our revenue cycle team. The A/R Specialist is responsible for following up on outstanding insurance and patient balances, resolving denied and rejected claims, filing timely appeals, and ensuring accurate, prompt collection of revenue owed to the practice. This role works closely with billers, coders, and front-office staff to identify root causes of delayed payment and recover revenue. Reports to the Medical Billing Supervisor.
Key Responsibilities Insurance Follow-Up & Collections- Work assigned A/R aging buckets daily; prioritize followup by dollar amount, payer, age, and timelyfiling risk.
- Contact commercial, Medicare, Medicaid, and Workers' Comp payers via phone, payer portals, and EDI to research claim status and resolve unpaid claims.
- Document every account touch with clear, timestamped notes capturing payer contact, reference numbers, next steps, and followup dates.
- Meet or exceed productivity standards and quality benchmarks set by leadership. Denials, Appeals & Rejections
- Review denied and rejected claims; identify root cause (coding, eligibility, authorization, medical necessity, timely filing, coordination of benefits, duplicate, etc.).
- Correct and resubmit claims; draft and submit timely written appeals with supporting documentation per payer requirements.
- Track appeal status, escalate aged appeals, and pursue secondlevel appeals when warranted.
- Identify denial trends by payer, CPT, provider, or location; report patterns to the supervisor to drive upstream fixes. Account Resolution & Adjustments
- Post payer adjustments, contractual allowances, and approved writeoffs accurately within practice management system policies.
- Submit refund requests, recoupment responses, and creditbalance resolutions in coordination with the billing supervisor. Reporting, Compliance & Collaboration
- Maintain accurate productivity logs; participate in weekly A/R review meetings and report on assigned Accounts.
- Comply with HIPAA, payer requirements, and internal policies; protect Protected
- Partner with coders, frontdesk, and clinical staff to resolve documentation, coding, or registration issues that affect claim payment.
- Contribute to process improvement by identifying inefficiencies and suggesting workflow or system enhancements.
Health Information (PHI) at all times.
Vacancy posted 7 days ago
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