Accounts Receivable Specialist

You’re more valuable than ever – And that’s just how we’ll make you feel.

Job Summary

The Accounts Receivable Specialist is responsible for follow up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients, patients and fellow staff.

Qualifications

Education Required:

• High school diploma or GED

Work Experience Required:

• 3+ years healthcare billing accounts receivable experience in a mid-to-large organization

Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.:

• 3+ years of Healthcare AR experience with large complex physician practice groups
• EMR experience across a minimum of one platform (i.e., Epic or Clinical Works)
• CPAR – Certified Patient Account Representative
• Certified Medical Billing Specialist
• Associate’s degree in Healthcare Management, Health information Management or related field

Knowledge, Skills, and Abilities

Technical Knowledge

• Working knowledge of CPT and ICD coding
• Knowledge of basic medical terminology
• Understanding of insurance guidelines, including Medicare, state Medicaid, and workers’ compensation across multiple states
• Ability to interpret and understand Explanation of Benefits (EOBs)
• Ability to accurately calculate deductibles and coinsurance

Communication & Interpersonal Skills

• This role involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.
• Ability to maintain strict patient confidentiality
• Excellent verbal and written communication skills
• Strong phone etiquette and customer service skills
• Ability to communicate effectively with patients regarding medical conditions and financial responsibilities
• Ability to represent the department professionally when interacting with patients, guests, physicians, and staff
• Ability to handle service issues tactfully and professionally and ensure appropriate follow-through

Organizational & Administrative Skills

• Proficiency in Microsoft Office applications, including Excel and Word
• Strong organizational and time management skills with the ability to prioritize effectively
• Proficiency in computer systems and typing
• Strong attention to detail, including mathematical accuracy

Teamwork & Collaboration

• Ability to work collaboratively across departments and function as an extension of urgent care centers
• Demonstrates flexibility and openness to new ideas and approaches
• Ability to remain focused and productive under pressure
• Proactively shares relevant information with team members
• Willingly assists others as needed
• Contributes to identifying and resolving enterprise-wide challenges

Essential Duties and Responsibilities

• Maintain accurate account and billing data by entering and updating patient demographic, guarantor, and insurance information; posting procedures and payments; and reconciling daily deposits.
• Manage accounts receivable through full lifecycle resolution, including:
  • Submitting claims via clearinghouses or directly to payers
  • Monitoring, researching, and resolving claim denials
  • Contacting insurance carriers to address payment issues
  • Filing appeals with appropriate documentation
  • Processing claim retractions, write-offs, and contractual adjustments in accordance with payer guidelines
• Ensure claim accuracy and compliance by entering complete and correct billing information, including patient details, insurance data, diagnosis and procedure codes, modifiers, and provider information.
• Review and post payments by:
  • Verifying insurance payments for accuracy and contract compliance
  • Posting insurance and patient payments within billing systems
  • Coordinating secondary billing for patients with multiple insurers
• Provide customer support and issue resolution by responding to inquiries from patients, providers, and insurance companies and assisting with inbound calls as needed.
• Verify insurance eligibility and benefits coverage to support accurate billing and reimbursement.
• Collaborate and communicate effectively with Team Leaders, Section Leaders, and cross-functional teams to provide updates, escalate issues, and support workflow efficiency.
• Deliver excellent customer service in all interactions with internal and external stakeholders.