RCM Accounts Receivable Specialist- Medical Billing Experience

Job Summary

The RCM Accounts Receivable Specialist is responsible for resolving outstanding insurance accounts receivable through proactive follow-up, denial management, appeals, and payer communication. This role focuses on maximizing reimbursement, identifying denial trends, and driving revenue cycle performance improvements for assigned client accounts.

Success in this role requires strong analytical skills, a deep understanding of healthcare reimbursement processes, and extensive daily use of Microsoft Excel and Outlook to manage account inventories, communicate with payers, track claim activity, and analyze denial trends.

Responsibilities

• Manage a portfolio of outstanding insurance accounts receivable, ensuring timely follow-up and resolution of unpaid or underpaid claims.
• Perform end-to-end denial management, including researching claim denials, identifying root causes, submitting appeals, and securing appropriate reimbursement.
• Analyze denial patterns and reimbursement trends to identify opportunities for process improvement and revenue recovery.
• Contact insurance carriers via phone, email, fax, payer portals, and written correspondence to resolve claim issues and payment delays.
• Investigate and resolve claim edits, rejections, authorization issues, coding discrepancies, and payer-specific reimbursement concerns.
• Follow up on aged accounts and claims with no response from insurance carriers while maintaining productivity and quality standards.
• Utilize Microsoft Excel to track accounts, analyze payer trends, manage work queues, create reports, and maintain denial inventories.
• Utilize Microsoft Outlook extensively for communication with payers, clients, and internal stakeholders regarding claim resolution activities.
• Review and apply current federal, state, Medicare, Medicaid, and payer-specific billing regulations.
• Handle Electronic Data Interchange (EDI) transactions, including reconciliation of carrier submissions, clearinghouse edits, and rejection reports.
• Leverage