Accounts Receivable Specialist

Job Description

Job Description

Function:The Accounts Receivable Representative is responsible for reviewing, researching, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This role requires strong knowledge of healthcare billing, payer guidelines, denial management processes, and revenue cycle operations. The representative works closely with insurance companies, providers, and internal departments to ensure accurate claim resolution and timely payment.Organizational duties & responsibilities:

1. The primary responsibility of all staff is to ensure the safety and well-being of all Ramey-Estep/Re-group (RE) clients.
2. Supports the mission, vision, and values of RE.  Facilitates and adheres to the agency’s code of ethics, policies, and procedures.
3. Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
4. Supports and facilitates positive interaction with clients and staff by exhibiting both in-office and in-public when carrying out job duties:  individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and awareness and sensitivity to cultural and other differences in clients and staff.
5. Exhibits effective communication skills, including proper use of agency communication systems.
6. Participates in appropriate professional development programs to attain and maintain competency.
7. Effectively manages financial and physical resources to achieve the mission of RE.
8. Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE.

Essential Duties and Responsibilities:

1. Review and analyze denied, rejected, and underpaid insurance claims.
2. Investigate denial reasons and identify appropriate corrective actions.
3. Prepare and submit first-level and second-level appeals to commercial, government, and managed care payers.
4. Monitor appeal status and follow up with insurance carriers to ensure timely resolution.
5. Research payer policies, contracts, and reimbursement guidelines to support dispute resolution.
6. Document all account activity, correspondence, and appeal actions accurately within billing systems.
7. Identify trends in denials and recommend process improvements to reduce future claim rejections.
8. Resolve claim discrepancies related to coding, eligibility, authorizations, medical necessity, and billing errors.
9. Maintain productivity and quality standards while managing assigned accounts receivable inventories.
10. Collaborate with coding, billing, patient access, and clinical departments to obtain supporting documentation.
11. Ensure compliance with HIPAA regulations, payer requirements, and organizational policies.
12. Meet departmental goals for collections, denial resolution, and aging account reduction.
13. Performs other duties as assigned/needed.

Working conditions/environment:

1. Shift is generally day shift, Monday - Friday.
2. Holidays, weekends, and extra hours may occasionally be required.
3. Meals are provided for staff when on campus.
4. Office setting with extensive computer usage. The role requires prolonged periods of computer work, telephone communication, and detailed account review.

minimum job requirements:Education:High School Diploma or GED required. 
Associate Degree in Business or Medical Billing and Coding field preferred; work experience or other education may be considered in lieu of a degree.Experience:Minimum 2 years of experience in healthcare (BH, CCBHC, RHC/FQHC, physician practice, or third-party billing), accounts receivable, denial management, medical billing, or revenue cycle operations.
Experience with insurance appeals, claim follow-up, and denial resolution.Specific Skills andrequirements:Must be at least 21 years of age.
Knowledge of Medicare, Medicaid, commercial insurance, and managed care payer regulations.
Knowledge of payer contract interpretation and reimbursement methodologies.
Familiarity with CPT, ICD-10, and HCPCS coding principles.
Proficiency in electronic medical records (EMR) and healthcare billing systems.
Strong analytical, problem-solving, and organizational skills.
Excellent written and verbal communication skills.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Technical requirements include proficiency with Microsoft Word, Excel, PowerPoint, and any other applications used by the organization or regulatory agencies.
Must also have ability to interface well with all departments in a highly professional manner.
Ability to understand and relate to the needs of clients from diverse backgrounds.
Ability to read, write and converse in English.
Successful completion of a pre-employment drug screen.
Successful completion of a background screening.
Successful completion of a TB skin test or proof of a negative chest x-ray or other documentation.Specialized Licenses or training:Successful completion of Excellent Foundations
Maintain 20 hours of annual training
Certification in medical billing, coding, or revenue cycle management is preferred.Physical Requirements:The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to stand, sit, walk, talk, hear, reach with hands and arms, and use hands to finger, handle, and feel.  This employee is also regularly required to use a computer keyboard and mouse.  The employee is occasionally required to stoop, kneel, crouch, and climb stairs.  The employee must occasionally lift and/or move up to 10 pounds or more.  Specific vision abilities required by this job include close vision, distance vision, and peripheral vision. Supervisory REquirements:N/A 

This position is also eligible for our full-time employee benefit package, which offers a generous 401(k) program with immediate vesting with dollar-for-dollar matching up to 6%, paid leave, health/dental/vision, and other competitive benefits!

The rate of pay for this position has range of $17.00/hour to $21.00/hour.

 

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