Accounts Receivable Specialist

Position Summary:
As an Accounts Receivable Specialist, you will manage tasks related to rejected, denied, and outstanding insurance claims, ensuring accuracy throughout the billing process. This includes addressing issues such as missing or incomplete documentation, delays in claim processing due to submission requirements, and credentialing concerns. Success in this role depends on thorough research, timely communication, and proactive problem-solving.

Key Responsibilities:
While this list includes primary duties, additional tasks may be assigned. Accommodations can be made for individuals with disabilities to perform essential functions.

• Complete accounts receivable collections and follow-ups to expedite insurance payments for assigned claims.
• Contact insurance companies via phone, mail, or clearinghouse correspondence to address account inquiries and update information.
• Communicate claim issues related to patient benefits to the verification team and field staff for resolution.
• Proactively collaborate with third-party payers to resolve claims processing issues, improve communication, and stay updated on changes to plan requirements.
• Assist in streamlining policies and procedures for more effective and efficient operations of third-party carriers, providing updates to the Billing Supervisor as needed.
• Prepare and assist with monthly reports, focusing on key indicators, payer issues, and unit performance, with a goal to improve metrics such as DSO (Days Sales Outstanding).
• Process appeals by gathering required documentation, resubmitting claims, and following up promptly to track resolution.
• Maintain compliance with HIPAA and CMS guidelines in all interactions and documentation.
  

Qualifications & Experience:
To succeed in this role, candidates must meet the following qualifications:

• Education: Bachelor’s degree or Associate’s degree with 3 years of professional office experience, or High School diploma/GED with 5 years of experience (healthcare setting preferred).
• Strong attention to detail and a thorough, results-oriented work ethic.
• Self-motivated, with a professional curiosity to learn and recommend innovative solutions.
• Excellent communication and interpersonal skills.
• Ability to adapt in a fast-paced environment, remain calm under pressure, and multitask effectively.
• Commitment to providing exceptional customer service, maintaining professionalism, and supporting team collaboration.
• Knowledge of insurance benefit coordination, medical billing, and credentialing.
• Ability to use independent judgment to handle confidential information responsibly.
• Experience analyzing and interpreting data to prepare actionable reports.
  
  

Computer Skills:
Proficiency in Microsoft Office applications (Outlook, Excel, Word, and Publisher). Experience with Internet browsers, including Chrome, Edge, and Firefox. Familiarity with EMR systems, clearinghouses, and medical billing software.

Work Environment & Physical Demands:
This role requires frequent communication by phone and email. Physical requirements include sitting, standing, walking, stooping, and using hands for various tasks. Vision abilities needed include close, distance, and peripheral vision, depth perception, and focus adjustment.