RCM Associate - Insurance AR Specialist - Remote

Summary

Under the direction of the RCM Supervisor - Back End the RCM Associate - Insurance AR Specialist is responsible for managing assigned insurance accounts receivable, resolving outstanding payer balances, addressing denials, and supporting timely reimbursement from third-party payers. This role supports revenue optimization, payer compliance, denial prevention, and accurate documentation of claim follow-up activity. Organization, attention to detail, prioritization, problem solving, and multitasking are necessary to ensure a high level of service to patients, physicians, payers, vendors, and OO staff.

Essential Duties and Responsibilities

Accounts Receivable Management

- Review, prioritize, and work assigned insurance accounts receivable by payer portfolio, aging category, balance, and department priority.

- Investigate and resolve unpaid, delayed, denied, underpaid, or incorrectly processed claims.

- Monitor payer payment trends, aging buckets, and unresolved balances to identify barriers to timely reimbursement.

- Identify payer denials, rejections, slow payment patterns, and recurring claim issues and escalate trends to leadership.

- Support reduction of aged AR by working accounts timely and documenting clear, actionable follow-up notes in the practice management system.

Denial Resolution and Claim Follow-Up

- Review payer denials and coordinate with Coding, Precertification, Charge Entry, Denial Management, and other RCM teams to resolve account issues.

- Submit corrected claims, appeals, reconsiderations, medical records, or additional documentation as needed based on payer requirements.

- Track payer responses, appeal outcomes, corrected claim status, and next steps in Athena or other approved PM/EMR systems.

- Follow up on outstanding insurance balances using payer portals, clearinghouse tools, phone calls, written correspondence, and internal workqueues.

- Identify authorization, eligibility, coding, demographic, modifier, medical necessity, timely filing, and documentation-related issues that affect payment.

Payer Collaboration and Escalation

- Contact payers professionally by phone, portal, or written correspondence to resolve claim disputes and secure appropriate reimbursement.

- Maintain professional communication with payer representatives, patients, internal team members, and leadership.

- Escalate unresolved payer issues, systemic denial trends, underpayment patterns, or contract-related concerns to RCM leadership or appropriate internal teams.

- Collaborate with Revenue Integrity, Contracting, Coding, Precertification, Front End, and Payment Posting teams to resolve root causes and prevent repeat AR issues.

Compliance, Documentation, and Reporting

- Ensure all activities comply with payer guidelines, government regulations, HIPAA requirements, and internal revenue cycle policies.

- Maintain complete, accurate, and audit-ready documentation for all claim resolution actions, payer communications, appeals, and account updates.

- Track daily productivity, AR aging performance, denial resolution activity, appeal outcomes, and assigned workqueue progress.

- Participate in AR team huddles, payer meetings, denial trending reviews, workflow improvement initiatives, and special projects as assigned.

- Recommend process improvements to enhance AR turnaround, collections efficiency, documentation quality, and denial prevention.

- Perform other duties as assigned.

Supervisory Responsibilities

This job has no formal supervisory responsibilities. The RCM Associate - Insurance AR Specialist may assist with training new team members, sharing workflow updates, supporting AR education, and serving as a resource for assigned payer or account follow-up processes as directed by leadership.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Customer Service - Works well with patients, vendors, payers, and physicians by keeping them informed and promoting a positive image of the company at all times. Exhibits good listening and comprehension; selects and uses appropriate communication methods. Responds professionally to account, billing, and payer-related questions and looks for ways to improve the patient and payer experience.

Teamwork - Accountable to team and departmental goals, works to meet established deliverables, balances team and individual responsibilities, gives and welcomes feedback, and puts success of the team above own interests. Communicates with RCM team members to support accurate claim resolution and timely reimbursement.

Organizational Support - Follows policies and procedures, completes administrative tasks correctly and on time, supports organization goals and values, and maintains patient confidentiality according to HIPAA guidelines.

Dependability - Adheres to the company time and attendance policy. Is punctual, maintains a good attendance record, has minimal to no missed punches, works independently with appropriate supervision, maintains focus, and adheres to departmental and companywide timelines.

Compliance - Adheres to company compliance policies, payer guidelines, HIPAA requirements, and applicable federal and state regulations related to billing, collections, and claim follow-up activity.

Productivity - Prioritizes and plans work activities to ensure completion of daily tasks. Uses time efficiently, works assigned accounts according to priority, and meets departmental productivity and quality expectations.

Job Knowledge - Competent in required job skills and knowledge; exhibits the ability to learn and apply new skills; keeps abreast of payer procedures, claim requirements, denial trends, reimbursement rules, and industry changes that may affect the department or patient service.

Analytical Problem Solving - Reviews claim history, remittance information, payer responses, and account documentation to identify root causes and determine appropriate next steps for resolution.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements include the knowledge, skill, and ability needed to support accurate insurance AR follow-up, denial resolution, payer communication, and compliant account documentation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High school diploma or general education degree (GED) required; associate degree preferred. Minimum of 3 years of experience in medical insurance billing, accounts receivable management, payer collections, claim follow-up, or revenue cycle operations preferred. Knowledge of Medicare, Managed Care, Commercial, Workers Compensation, and out-of-network payer policies preferred. CPAR certification preferred but not required. Experience with Athena or similar PM/EMR systems preferred.

Language Skills

Ability to read and interpret payer correspondence, remittance advice, claim notes, denial information, appeal requirements, procedure manuals, and internal workflow instructions. Ability to write clear account notes, correspondence, appeal summaries, and routine reports. Ability to communicate effectively in one-on-one and small group situations with patients, payers, clients, physicians, vendors, and other employees of the organization.

Mathematical Skills

Ability to calculate figures and amounts such as adjustments, balances, percentages, payment variance, reimbursement amounts, contractual differences, patient responsibility, and aging totals.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed written or oral instructions. Ability to investigate claim history, payer responses, account documentation, and remittance data to resolve problems involving multiple variables and determine appropriate next steps.

Computer Skills

To perform this job successfully, an individual should have knowledge of Electronic Medical Records (EMR) and Practice Management systems, preferably Athena; payer portals; clearinghouse tools; Outlook; Microsoft Word; and Microsoft Excel. Skills in operating computers, scanning, copying, faxing, phones, and other office equipment are preferred.

Certificates, Licenses, Registrations

CPAR (Certified Patient Account Representative) preferred but not required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands regularly; and talk or hear. The employee is required to stand, walk, and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision. May be required to travel to one or more satellite locations depending on staffing changes. May be required to participate in educational courses that correspond with current systems or functionalities.

Work Environment

The noise level in the work environment is usually moderate. The employee may work in a fast-paced revenue cycle environment with frequent computer, payer portal, phone, and account review activity.