Accounts Receivable Specialist

NextCare•Tempe, AZ

10d

About The Position

The accounts receivable specialist will be responsible for maintaining the organization's financial health, with a focus on timely and accurate resolution of outstanding medical claims. The accounts receivable specialist is required to have a deep understanding of the medical billing lifecycle, advanced knowledge or payer guidelines, and a proven ability to reduce accounts receivable aging through proactive follow up and denial management.

Requirements

Education: Minimum of High School diploma or equivalent.
Experience: Minimum of 5 years of experience in medical billing or accounts receivable with a strong emphasis on insurance claim resolution and denial management.
Knowledge: In-depth understanding of medical billing and coding principles (CPT, ICD-10, HCPCS) and payer reimbursement methodologies.
Technical Skills: Proficiency with medical billing software; experience with NextGen Billing strongly preferred. Waystar Clearinghouse expertise required.
Analytical Skills: Strong ability to interpret EOBs, remittance advice, and payer correspondence to resolve complex claim issues.
Attention to Detail: Exceptional accuracy in data entry, financial reconciliation, and documentation.
Communication Skills: Effective written and verbal communication skills to interact with payers, internal teams, and external stakeholders in a professional manner.

Nice To Haves

Technical Skills: Proficiency with medical billing software; experience with NextGen Billing strongly preferred.

Responsibilities

Pre-claim Eligibility and Benefits: Verify patient insurance eligibility and benefits before claim submission
Clearinghouse Rejections: Review and analyze clearinghouse rejections and identify root causes for rejected claims.
Claims Management: Monitor and follow up on unpaid and denied medical claims across a variety of payers (Commercial, Medicare, Medicaid, Workers Comp Carriers, etc.) to ensure timely reimbursement.
Denial Resolution: Research, analyze, and resolve claim denials and underpayments by identifying root causes, correcting errors, submitting appeals, or providing additional documentation as needed.
Account Reconciliation: Reconcile accounts receivable by posting adjustments and resolving discrepancies to maintain accurate financial records.
Trend Analysis & Reporting: Generate and analyze A/R reports to identify patterns in denials, reimbursement delays, or system inefficiencies, and recommend process improvements.
Collaboration: Partner with billing, coding, and compliance teams to ensure claims are processed accurately and efficiently.
Compliance: Maintain strict adherence to HIPAA regulations, payer-specific guidelines, and company policies to ensure data integrity and patient confidentiality
Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
Performs other related duties as assigned or described in Company policy.