Medical Account Receivable Specialist (Level 3)

Aspire Allergy & Sinus•Austin, TX

12d•Onsite

About The Position

Aspire Allergy & Sinus is seeking a full-time Medical Accounts Receivable Specialist (Level 3) to serve as a subject matter expert (SME) responsible for resolving complex, high-dollar, and systemic reimbursement issues. This role evaluates assigned payer accounts, including working rejections, invalid and denied claims, appeals, escalated patient account concerns, and follow-up activities to bring accounts to final resolution in a timely manner and within industry-standard benchmarks. The Level 3 AR Specialist also identifies root causes of reimbursement challenges, supports Accounts Receivable operations across all financial classes as needed, and ensures compliance with industry regulations, practice protocols, and company policies while driving overall revenue cycle performance.

Requirements

Exceptional ability to investigate complex data sets, perform root cause analysis on denial trends, and solve ambiguous billing or reimbursement puzzles independently
Expert-level mastery of insurance workflows, advanced appeal strategies, coding rules, and diverse payer reimbursement logic
Strong capacity to navigate high-dollar disputes and confidently implement advanced resolution pathways under minimal supervision
Ability to articulate complex policy concepts clearly, serving as an approachable technical resource and mentor to junior staff
Excellent written and verbal communication skills
Ability to prioritize and manage multiple workflows and deadlines
Must possess the ability to maintain effective working relationships with patients, medical staff and the public
Must possess the ability to react calmly and effectively in a difficult or emergent situation, including de-escalating sensitive patient concerns.
Minimum of 5–7 years of medical billing, collections, and accounts receivable experience within a healthcare environment.
Proven track record of independently resolving high-dollar, complex denials and dealing directly with difficult payer scenarios.
Advanced proficiency with electronic health record (EHR) systems, clearinghouses, and medical billing software.
High School Diploma or higher

Nice To Haves

Certified Revenue Cycle Specialist (CRCS), Certified Professional Coder (CPC), or equivalent revenue cycle certification.
Prior experience in a "Tier 3" or Senior/SME AR role, or experience auditing insurance reimbursement workflows.
Experience utilizing data analytics tools (e.g., advanced Excel, Tableau, or Power BI) to track and report on denial trends.
Experience in Allergy & Sinus Specialty
Experience with NextGen EHR

Responsibilities

Resolve highly complex and high-dollar reimbursement issues.
Perform root cause analysis on denial trends and payer behavior.
Manage systemic payer issues affecting multiple claims or locations.
Serve as the escalation point for Level 1 and Level 2 AR Specialists, including the resolution of the most complex patient account and payer concerns.
Handle sensitive and complex patient interactions, providing advanced problem-solving and de-escalation for challenging account issues.
Develop advanced appeal strategies and resolution pathways.
Interpret complex payer policies, coding rules, and reimbursement logic.
Identify breakdowns in payer processes and recommend corrective action.
Support process improvement initiatives across the revenue cycle.
Provide guidance on complex claim scenarios and payer disputes.
Review and approve account write-offs and adjustments up to $1,000; escalate amounts exceeding this threshold for management approval.
Assist with standard Level 1 and Level 2 Accounts Receivable responsibilities across all financial classes as business needs require.