Accounts Receivable Specialist

Onco360 • Louisville, KY

14d • Onsite

About The Position

The Accounts Receivable Specialist participates in daily operational functions related to managing and collecting company-wide accounts receivable. The role works with insurance companies, healthcare providers, and patients to process and resolve claims and payments, including redeterminations and appeals. It also involves interpreting pharmacy and medical claims and remittance advice, monitoring payments and denials, following up on aged accounts, and assisting patients with billing and accounts receivable inquiries.

The specialist works with the cash team and other staff to ensure payment postings are properly accounted for and resolved in a timely manner. The position requires a courteous, helpful, and respectful approach to patients, colleagues, payers, and management; adherence to company policies, compliance requirements, applicable laws, and professional standards; and willingness to work overtime when necessary to meet department goals. The role may also involve demonstrating leadership and constructively working with and supervising others.

Requirements

• High school diploma or GED.
• 2–3 years of healthcare accounts receivable experience.
• Knowledge of NDC medication billing, PBM and medical contracts, Medicare programs, and coordination of benefits.
• Healthcare audit experience.
• Deadline-oriented behavior, time management, prioritization skills, and ability to work independently.

Nice To Haves

• Certified Pharmacy Technician qualification.
• Associate or bachelor's degree.
• Pharmacy-specific receivables experience.
• National or state pharmacy technician certification.

Responsibilities

• Work directly with insurance companies, healthcare providers, and patients to get claims processed and paid appropriately, including redeterminations and appeals.
• Interpret pharmacy and medical claims and remittance advice.
• Understand HCPC, ICD-10, and/or medication NDC in conjunction with claim billing activity.
• Work with electronic claim adjudication and NDPDP D.0 standards and rejections.
• Complete claim updates and corrections as needed.
• Apply knowledge of Medicare and Medicaid pharmacy program and reimbursement guidelines.
• Monitor electronic remittances and manual payments and denials to ensure proper payment posting and accurate receivables.
• Coordinate with the cash team to ensure pending payment postings are properly accounted for and resolved promptly.
• Monitor the A/R Dashboard and system A/R Manager to identify aged accounts requiring follow-up and prioritize activities with staff.
• Manage time effectively while monitoring and following up on assigned aged claims.
• Serve as a resource for patients with billing and accounts receivable inquiries, including explaining copay structures and accepting patient payments.
• Perform other tasks as assigned by the Manager, Director, and/or Executive leadership.
• Maintain a positive, courteous, respectful, and helpful attitude toward patients, team members, payers, and management.
• Meet specified deadlines and be open to overtime when necessary to meet department goals and objectives.
• Conduct job responsibilities in accordance with the company Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and professional standards.
• Demonstrate leadership and constructively work with and supervise others.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) with a match
• Paid time off
• Paid holidays
• Tuition reimbursement
• Company-paid life insurance
• Company-paid short- and long-term disability

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED