Accounts Receivable Specialist

Community Care Cooperative•Boston, MA

13d•Remote

About The Position

We are seeking an experienced Accounts Receivable Specialist to join our revenue cycle team. The ideal candidate will have a strong background in professional billing or working in a doctor's office, with a preference for experience in Federally Qualified Health Centers (FQHC). The position requires a detail-oriented and collaborative professional responsible for the implementation, configuration, optimization, and support of Epic’s Resolute Professional Billing (PB) module. This role ensures accurate and efficient billing workflows, charge capture, claims processing, and reimbursement across the healthcare revenue cycle. Familiarity with Massachusetts healthcare regulations, electronic health records (EHRs), and related software is essential for success in this role.

Requirements

Knowledgeable of Massachusetts healthcare billing regulations and payer requirements
Minimum of 3-5 years of experience in medical billing, preferably in an FQHC or professional billing setting
Proficiency in Epic resolute professional billing processes
Strong understanding of claim form logic and payer-specific billing requirements
Familiarity with Massachusetts healthcare regulations and insurance processes
Knowledge of medical coding (CPT, ICD-10, HCPCS) and compliance requirements
Excellent attention to detail, organizational skills, and the ability to meet deadlines
Strong communication and problem-solving skills
Solid communication skills across stakeholders, diligence, and problem-solving skills
Experience in Microsoft Office Suite
Must have a strong commitment to quality assurance and exceptional customer service.
A strong commitment to C3’s mission

Nice To Haves

Familiarity with the MassHealth ACO program
Familiarity working in Federally Qualified Health Centers (FQHC)
Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Responsibilities

Enter and review charges for accuracy, ensuring proper coding and compliance with payer requirements
Utilize the charge router within Epic to route charges efficiently and accurately to the correct claim workflows
Identify and resolve charge capture errors or discrepancies to prevent billing delays
Prepare, review, and submit electronic and paper claims through Epic and various clearinghouses, ensuring compliance with FQHC billing guidelines and Massachusetts-specific regulations
Apply claim form logic to review and resolve formatting errors before submission
Liaise with insurance companies to resolve discrepancies, missing files, and claim rejections
Analyze claim form logic, including UB-04 and CMS-1500 formats, to ensure proper billing practices are followed
Monitor claims for timely submissions by working closely with follow-up colleagues to address rejected or denied claims
Assist in managing accounts receivable by identifying trends in denials or delays
Perform payer appeals on denied claims as needed
Leverage Epic systems and other EHRs to support billing workflows, payment posting, and reporting
Reconcile daily payment batches to ensure all funds are accounted for and discrepancies are resolved promptly
Monitor unapplied payments and resolve posting errors in a timely manner
Work with banking institutions to ensure accurate deposit processing and address returned or rejected transactions
Function as a point of contact for inquiries related to payment posting and ERA processes
Generate and analyze payment posting and cash reconciliation reports to identify trends and areas for improvement
Maintain and update patient accounts and payer information in the system as needed
Collaborate with IT and billing teams to address system-related issues impacting billing processes
Ensure billing practices comply with FQHC-specific guidelines, Massachusetts healthcare regulations, and payer rules
Stay updated on changes to coding guidelines, billing codes, payer policies, and industry best practices
Participate in internal and external audits as required
Partner with clinical, coding, and health information teams to resolve billing documentation issues
Communicate effectively with insurance companies, patients, and other stakeholders to address billing inquiries
Review billing dashboards as a tool to monitor performance metrics and identify denial trends
Provide feedback to leadership on areas for improvement within billing workflows
Communicate effectively with insurance payers, patients, and internal teams to resolve billing and payment issues
Provide excellent customer service when assisting with account inquiries or payment concerns.
Other duties as assigned