Senior Medical Accounts Receivable Specialist

Health Plus Management•Uniondale, NY

7d•Onsite

About The Position

The Senior Medical Accounts Receivable Specialist is responsible for managing complex insurance accounts receivable, reducing outstanding A/R, resolving claim denials, and maximizing reimbursement while ensuring compliance with payer and regulatory requirements. This role serves as a subject matter expert within the Revenue Cycle team, providing guidance to team members, identifying workflow improvements, and collaborating with internal departments to resolve reimbursement issues efficiently.

Requirements

High school diploma or equivalent.
Minimum of 5 years of medical accounts receivable experience.
Minimum of 3 years of experience handling complex insurance follow-up and appeals.
Strong knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and payer guidelines.
Experience with commercial insurance, Medicare, Medicaid, Workers' Compensation, and No-Fault claims.
Proficiency using electronic medical records (EMR) and practice management systems.
Advanced knowledge of payer portals and claim status tools.
Strong analytical and problem-solving skills.
Excellent written and verbal communication skills.
Ability to prioritize multiple deadlines in a fast-paced environment.

Nice To Haves

CPC, CPB, or other AAPC certification preferred
Orthopedic or surgical specialty experience preferred
Experience with Athenahealth or similar practice management systems preferred
Experience with denial analytics and revenue cycle reporting preferred

Responsibilities

Manage a portfolio of high-value and aged insurance accounts receivable.
Investigate and resolve denied, underpaid, and delayed claims across commercial, Medicare, Medicaid, Workers' Compensation, No-Fault/MVA, and other payers.
Prepare and submit first- and second-level appeals with supporting clinical documentation.
Analyze payer trends and identify root causes of denials.
Work closely with coding, authorization, front desk, providers, and billing staff to resolve claim issues.
Review payer contracts to identify reimbursement discrepancies.
Follow up on outstanding claims through payer portals and direct communication with insurance representatives.
Monitor timely filing deadlines and appeal timeframes.
Document all account activity accurately within the practice management system.
Recommend workflow improvements to reduce denials and improve reimbursement.
Assist with training and mentoring new Accounts Receivable Specialists.
Escalate complex reimbursement issues to leadership when appropriate.
Maintain productivity and quality standards established by the department.
Participate in special projects and revenue cycle initiatives as assigned.
Manage and follow up on medical lien cases, including communicating with attorneys, insurance carriers, and third-party administrators to facilitate timely reimbursement.