Accounts Receivable Specialist

Ramey-Estep / Re-group•Ashland, KY

23d•$17 - $21•Onsite

About The Position

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.

Requirements

High School Diploma or GED required.
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.
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.

Nice To Haves

Associate Degree in Business or Medical Billing and Coding field preferred; work experience or other education may be considered in lieu of a degree.
Certification in medical billing, coding, or revenue cycle management is preferred.

Responsibilities

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