Accounts Receivable Specialist

The Accounts Receivable Specialist performs resolution-oriented activities with a focus on comprehensive medical billing, payment posting, and/or collection actions. While ensuring compliance with relevant laws, regulations, and established company policies and compliance programs, this role is responsible for efficient cash collections through excellent reimbursement practices, accurately posting of EFT, credit card, ACH, and check insurance/patient payments, and/or performing accurate claim billing. This role, reporting to our AR Supervisors and/or AR Quality & Support Supervisor, will have an emphasis on process execution and quality control. Key Responsibilities Payment Posting: EFT, credit card, ACH, live check, and insurance payments. Researches and evaluates insurance payments and correspondence for accuracy and process/post insurance and patient payments. Matches EOB and payment records with payments, processes write‑offs, batches, and scans payments with applicable record keeping. Billing: Accurate and timely submission of all claims for all payers, review and prepare daily claim/invoice submission for primary, secondary, and tertiary payers and/or patient statements. Review rejected claims, perform correction activities, and ensure resubmission as appropriate. Ensure all Contract Billing Partner billing is submitted to appropriate outsourced partner. Collections: Timely and accurate follow‑up on unpaid claims or patient accounts, work assigned lists of outstanding claim balances and/or patient accounts with multifaceted issues across different payers and patients. Identify trends, conduct follow‑up and perform root cause analysis on unpaid and under‑paid insurance claims across different payers. Analyze and resolve billing discrepancies on patient accounts, communicate findings to patients. Draft appeals and effectively overturn denied or under‑paid claims, remediation, appeals research, re‑bill & payer resolution. Compliance Compliance: Prepares year‑end schedules for Review and other regulatory agencies, assists in monitoring compliance with Medicare regulations. Adheres to all relevant regulations and agency policies regarding patient intake and data management, including but not limited to: CMS and OFCCP guidelines related to our Quality Management System, documentation and process creation and training. Essential Skills Analytical Skills: Ability to analyze data, identify trends, and make recommendations. Communication Skills: Excellent communication and interpersonal skills to effectively collaborate. Technical Skills: Proficiency in accounting software, Microsoft products with proficiency in Excel. Excellent organizational and time management skills: To manage a high volume of work and ensure timely processing of information. Attention to detail: To ensure accuracy in patient records and insurance information. Problem‑solving skills: To address any issues or challenges that may arise during the intake process and within the established AR department workflow. Experience College degree preferred or related previous experience. 1 year minimum: Claim submission, payment posting, appeal and denial processes, medical device billing and/or general healthcare reimbursement, Medicare and commercial insurance carriers plan configurations in respect to calculations of coinsurance, deductibles and percentages. Preferred In‑Depth Knowledge: Healthcare methodologies in coding, coverage, criteria, payments. Job Requirements & Physical Demands Must be able to lift 40 pounds, must be able to lift 40 pounds from the floor and lift to waist level. Must be able to kneel, stoop, climb stairs and reach with hands and arms. Reliable work transportation. Candidates must pass an extensive background check. Strict adherence to HIPAA, Medicare Fraud, Waste, and Abuse and privacy regulations in all patient interactions. This job description outlines essential duties but is not exhaustive. Employees may be assigned other tasks. All duties are subject to modification for disability accommodation. Successful performance requires specific skills and abilities. This document sets minimum requirements and does not imply an employment contract. The company is an equal opportunity employer, drug‑free workplace, and complies with ADA regulations as applicable. #J-18808-Ljbffr BioTAB Healthcare