Accounts Receivable Specialist- Medical Billing Experience

Netsmart•Remote - KS, KS

About The Position

The RCM Accounts Receivable Specialist resolves outstanding insurance accounts receivable through proactive follow-up, denial management, appeals, and payer communication. The role focuses on maximizing reimbursement, identifying denial trends, and improving revenue cycle performance for assigned client accounts. The position requires strong analytical skills, knowledge of healthcare reimbursement processes, and extensive daily use of Microsoft Excel and Outlook to manage account inventories, communicate with payers, track claim activity, and analyze denial trends.

Requirements

High school diploma or GED.
At least 1 year of healthcare accounts receivable, medical billing, or denial management experience.
Demonstrated experience researching and resolving insurance claim denials and payer reimbursement issues.
Advanced Microsoft Excel skills, including VLOOKUPs/XLOOKUPs, Pivot Tables, filters, formulas, and spreadsheet management.
Strong proficiency in Microsoft Outlook, including management of high-volume email communications and claim follow-up correspondence.
Understanding of insurance reimbursement processes, claim adjudication, Medicare, Medicaid, and commercial payer requirements.
Strong analytical, critical-thinking, and problem-solving skills.
Excellent verbal and written communication skills.
Ability to manage productivity metrics and work independently in a fast-paced environment.

Nice To Haves

Experience in behavioral health, post-acute care, home health, long-term care, or specialty healthcare billing.
At least 2 years of insurance AR follow-up and denial management experience.
Collections experience in a healthcare revenue cycle environment.
Experience preparing and submitting formal appeals to insurance carriers.
Working knowledge of medical billing systems such as Medic, IDX, Avatar, Tier, Medical Manager, or similar platforms.
Experience with automation tools, AI-enabled workflows, or revenue cycle technology solutions.

Responsibilities

Manage a portfolio of outstanding insurance accounts receivable and follow up promptly to resolve unpaid or underpaid claims.
Research claim denials, identify root causes, submit appeals, and secure appropriate reimbursement.
Analyze denial patterns and reimbursement trends to identify process improvements and revenue recovery opportunities.
Contact insurance carriers by phone, email, fax, payer portals, and written correspondence to resolve claim issues and payment delays.
Investigate and resolve claim edits, rejections, authorization issues, coding discrepancies, and payer-specific reimbursement concerns.
Follow up on aged accounts and claims without a response from insurance carriers while maintaining productivity and quality standards.
Use Microsoft Excel to track accounts, analyze payer trends, manage work queues, create reports, and maintain denial inventories.
Use Microsoft Outlook for high-volume communication with payers, clients, and internal stakeholders about claim resolution.
Review and apply current federal, state, Medicare, Medicaid, and payer-specific billing regulations.
Handle EDI transactions, including reconciling carrier submissions, clearinghouse edits, and rejection reports.
Use RPA tools and AI-assisted workflows to enhance efficiency, automate routine follow-up, and improve claim resolution outcomes.
Maintain detailed documentation of account activity and claim resolution efforts.