Accounts Receivable Specialist
About The Position
Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals. Job Description Full Cycle Accounts Receivable Management Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution. Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers. Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable. Denial & Claim Resolution Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions. Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines. Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements. Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers. Payer & Client Communication Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues. Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts. Build strong relationships with payer representatives to improve overall reimbursement efficiency. Regulatory & Systems Expertise Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines. Review and resolve EDI rejections, claim edits, and submission errors. Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity. Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.
Requirements
- High school diploma or GED.
- Minimum 1 year of medical billing, claims, or A/R experience.
- Advanced Microsoft Excel skills (vlookups, pivot tables, data organization).
- Strong analytical, investigative, and problem-solving skills.
- Excellent verbal and written communication skills.
- Demonstrated ability to work independently, meet deadlines, and achieve productivity goals.
- Basic understanding of insurance plans, medical terminology, Medicare and Medicaid billing guidelines.
Nice To Haves
- Experience in behavioral health, home care, long-term care, or similar clinical billing environments.
- Prior healthcare collections or reimbursement experience.
- Experience with medical billing platforms such as Medic, IDX, Avatar, Tier, Medical Manager, or similar systems.
- Exposure to or interest in automation, AI-supported workstreams, or RPA technologies used in revenue cycle operations.
Responsibilities
- Full Cycle Accounts Receivable Management
- Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution.
- Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers.
- Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable.
- Denial & Claim Resolution
- Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions.
- Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines.
- Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements.
- Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers.
- Payer & Client Communication
- Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues.
- Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts.
- Build strong relationships with payer representatives to improve overall reimbursement efficiency.
- Regulatory & Systems Expertise
- Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines.
- Review and resolve EDI rejections, claim edits, and submission errors.
- Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity.
- Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
