Medical Accounts Receivable Specialist 2

Hologic•San Diego, CA

About The Position

The Medical AR Specialist 2 manages complex medical accounts receivable activities with a focus on third‑party payer billing, denial resolution, and appeals processing. The role is responsible for ensuring timely follow‑up on outstanding claims, resolving payer issues, and maximizing collections while maintaining compliance with billing regulations. This position analyzes denial trends and payer performance, investigates rejected claims, collaborates with internal teams and providers, and supports departmental financial goals such as cash collections and DSO. The specialist works independently on complex accounts while escalating advanced appeals and systemic payer issues when needed.

Requirements

High school diploma or GED equivalent
5–10 years of experience in healthcare revenue cycle, medical billing, or accounts receivable
Demonstrated experience with third‑party payer follow‑up, denial management, and appeals processing
Experience resolving complex patient accounts and insurance claim issues
Experience using revenue cycle management systems such as Xifin or similar platforms
Experience analyzing AR trends, payer performance, and collection outcomes
Experience working with payer correspondence, remittance advice, and EOB review for payment accuracy and discrepancies
Knowledge of Healthcare revenue cycle processes, including billing, claims adjudication, and accounts receivable management
Knowledge of Third‑party payer requirements for commercial and government health plans
Knowledge of Medical coding standards including ICD‑10, CPT, LCD, and NCD guidelines
Knowledge of Denial management and appeals processes across multiple appeal levels
Knowledge of Payer contract terms, reimbursement policies, and payment variance identification
Knowledge of Healthcare regulatory requirements including HIPAA and billing compliance
Knowledge of Accounts receivable performance metrics such as aging, collections, and DSO
Knowledge of Billing platforms and revenue cycle systems (e.g., Xifin or similar)
Knowledge of Microsoft Excel and reporting tools for analyzing AR performance and payer trends
Skills in Third‑party payer follow‑up and collection management
Skills in Denial investigation, claim correction, and resolution
Skills in Appeals preparation, submission, tracking, and outcome evaluation
Skills in Analytical skills for identifying trends, payer issues, and root causes of denials
Skills in Data analysis and reporting of AR performance and payer activity
Skills in Problem solving and troubleshooting complex billing or payment discrepancies
Skills in Time management and ability to manage multiple accounts and deadlines
Skills in Effective written and verbal communication with payers, providers, and internal stakeholders
Skills in Customer service and inquiry resolution related to patient and client accounts
Skills in Accurate data entry, insurance verification, and demographic review
Behaviors / Competencies: Self‑motivated and able to work independently with minimal supervision
Behaviors / Competencies: Detail‑oriented with strong focus on accuracy and compliance
Behaviors / Competencies: Analytical and proactive in identifying and resolving issues affecting collections
Behaviors / Competencies: Organized and able to prioritize tasks in a fast‑paced environment
Behaviors / Competencies: Collaborative team member who contributes insights and supports cross‑training
Behaviors / Competencies: Adaptable to changing business needs and workloads
Behaviors / Competencies: Persistent and solution‑focused when addressing complex payer issues
Behaviors / Competencies: Professional, respectful, and service‑oriented in interactions with stakeholders

Nice To Haves

Experience in laboratory billing or diagnostic testing environments

Responsibilities

Manages complex medical accounts receivable activities with a focus on third‑party payer billing, denial resolution, and appeals processing.
Ensures timely follow‑up on outstanding claims.
Resolves payer issues and maximizes collections while maintaining compliance with billing regulations.
Analyzes denial trends and payer performance.
Investigates rejected claims.
Collaborates with internal teams and providers.
Supports departmental financial goals such as cash collections and DSO.
Works independently on complex accounts.
Escalates advanced appeals and systemic payer issues when needed.