Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable (A/R) Specialist is responsible for managing the collection of outstanding patient and insurance balances, submitting claim corrections and appeals as necessary, and maintaining accurate, up-to-date accounts receivable records. This role serves as a key point of contact for patients, clinic staff, and insurance carriers by addressing billing inquiries and resolving concerns through phone and online communication. The A/R Specialist plays an integral role in supporting the organization's financial stability by ensuring timely reimbursement, maximizing reimbursement through reduced accounts receivable aging, and delivering exceptional customer service to patients.

Duties and Responsibilities

• Monitor and manage accounts receivable work queues and aging reports to resolve outstanding insurance and patient balances.
• Follow up on unpaid, denied, and underpaid claims via phone calls, payer portals, and written correspondence.
• Investigate and resolve claim denials, payment discrepancies, coordination of benefits issues, registration errors, coding issues, authorization-related denials and other reimbursement barriers in a timely and efficient manner.
• Submit corrected claims, appeals, reconsiderations, and supporting documentation to insurance carriers.
• Identify and escalate problem accounts or denial trends to leadership.
• Communicate professionally with insurance companies, patients, and internal staff to resolve outstanding accounts.
• Assist patients with billing inquiries and provide clear explanations regarding insurance processing, balances, and financial responsibility.
• Maintain detailed documentation of collection efforts, account activity, and claim follow-up actions.
• Meet productivity, quality, and collection targets set by the Revenue Cycle Manager.
• Ensure compliance with HIPAA regulations and internal policies regarding patient information and billing practices.
• All other duties as directed by MOS Leadership.

Education, Experience, Licenses, and Certifications

• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, Finance, or a related field preferred.
• Two years of accounts receivable experience in a medical practice setting preferred; experience with professional medical claims in an orthopedic or specialty practice strongly preferred.
• Working knowledge of commercial, government, and liability insurance payers and reimbursement methodologies.
• Demonstrated experience in claims denial management, including denial analysis, appeals preparation and submission, and insurance follow-up.
• Proficient knowledge of medical coding and billing concepts, including CPT, ICD-10-CM, and HCPCS coding systems.
• Ability to accurately interpret and analyze Explanation of Benefits (EOBs), Explanation of Payments (EOPs), and Electronic Remittance Advices (ERAs).
• Strong understanding of Coordination of Benefits (COB), out-of-pocket maximums, deductibles, coinsurance, copayments, and other patient financial responsibility components.
• Proven experience interacting directly with patients and delivering exceptional customer service in a professional healthcare environment.
• Strong analytical, organizational, and problem-solving skills with attention to detail and accuracy.
• Proficiency in electronic medical record (EMR) and practice management systems preferred.

Our company participates in E-Verify to confirm the employment eligibility of all newly hired employees, as required by federal law.

Michigan Orthopaedic Surgeons