Healthcare Accounts Receivable & Insurance Follow-Up Specialist

Balboa Care Nephrology Research Enterprise United•San Diego, CA

12d•Hybrid

About The Position

The Healthcare Accounts Receivable & Insurance Follow-Up Specialist is responsible for managing and resolving outstanding insurance and patient accounts to maximize reimbursement and reduce accounts receivable aging. This role performs comprehensive claim follow-up, denial resolution, appeals management, payment research, and account reconciliation while maintaining compliance with payer, regulatory, and organizational requirements. The ideal candidate possesses strong knowledge of healthcare billing, insurance reimbursement, payer guidelines, and revenue cycle operations. Success in this role requires critical thinking, attention to detail, persistence in resolving complex claims issues, and the ability to work collaboratively with billing, coding, clinical, and payer representatives to achieve timely and accurate reimbursement. This position plays a key role in improving cash flow, reducing aged receivables, and supporting the organization's overall revenue cycle performance through proactive account management and effective resolution of billing and payment barriers.

Requirements

2 or more years recent professional medical billing/collection experience for a physician practice.
Knowledge of medical terminology and CPT/HCPS codes and modifiers
Demonstrated knowledge of medical terminology, CPT, HCPCS, ICD-10 and modifier codes, including impact on coverage and reimbursement.
Knowledge of collection processes and collection laws.
Vast payor experience including Medicare, Medi-Cal, HMO, FFS, PPO and IPA’s.
Strong proficiency with Microsoft Windows (ability to navigate, create and rename folders, save and organize files),
Strong proficiency with Microsoft Office products (Outlook, OneNote, Teams, Excel, Word), proficiency with Adobe PDF.
Ability to type 30 words per minute.
Reside within San Diego County, CA
High School graduate required
Excellent verbal and written communication.
Ability to provide excellent customer service.
Ability to interpret, adapt and apply guidelines and procedures.
Ability to use good reasoning and judgement and react appropriately in emergency situations.
Ability to establish and effective working relationships with patients, medical staff, and coworkers.
Ability to multitask and stay organized.
Detail oriented and ability to prioritize work.
Background check required
While performing duties, the employee is regularly required to talk, hear, read, write, type and respond in English and understand clinical/medical vocabulary written and spoken.
Vision requirements include close vision, ability to adjust focus, and see color.

Nice To Haves

Proficient with the Epic billing system
Bilingual in English and Spanish
Nephrology specific experience
3 or more years recent Medical A/R experience working denials and self-pay follow up.

Responsibilities

Completes efficient and appropriate follow up activities on outstanding Medical A/R as assigned following procedures
Contacts patients to follow up on outstanding self-pay balances, take payments, setup payment plans and/or initiate financial assistance
Submits effective appeals resulting in higher propensity to pay
Submits and/or attaches correct medical documentation to support prompt payment of claims based on payor requirements
Works assigned charge review and claim edits accordingly
Promptly responds to billing inquiries from patients, insurance companies and clinics in order to resolve account/claim issues while providing outstanding service
Provides outstanding customer service when answering patient billing questions via inbound calls
Identifies issues impacting quality and timely reimbursement and proposes potential solutions
Exceeds quality and productivity standards
Supports and actively participates in process improvement initiatives
Assists with other duties to support the revenue cycle process and Balboa’s core values as assigned
Other duties as assigned.