Accounts Receivable Specialist

Duties and Responsibilities

• Monitor and manage accounts receivable work queues and aging reports to resolve outstanding insurance and patient balances.
• Follow up on unpaid, denied, and underpaid claims via phone calls, payer portals, and written correspondence.
• Investigate and resolve claim denials, payment discrepancies, coordination of benefits issues, registration errors, coding issues, authorization-related denials and other reimbursement barriers in a timely and efficient manner.
• Submit corrected claims, appeals, reconsiderations, and supporting documentation to insurance carriers.
• Identify and escalate problem accounts or denial trends to leadership.
• Communicate professionally with insurance companies, patients, and internal staff to resolve outstanding accounts.
• Assist patients with billing inquiries and provide clear explanations regarding insurance processing, balances, and financial responsibility.
• Maintain detailed documentation of collection efforts, account activity, and claim follow-up actions.
• Meet productivity, quality, and collection targets set by the Revenue Cycle Manager.
• Ensure compliance with HIPAA regulations and internal policies regarding patient information and billing practices.

Qualifications

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field preferred.
• Two years of accounts receivable experience in a medical practice setting preferred; experience with professional medical claims in an orthopedic or specialty practice strongly preferred.
• Working knowledge of commercial, government, and liability insurance payers and reimbursement methodologies.
• Demonstrated experience in claims denial management, including denial analysis, appeals preparation and submission, and insurance follow-up.
• Proficient knowledge of medical coding and billing concepts, including CPT, ICD-10-CM, and HCPCS coding systems.
• Ability to accurately interpret and analyze Explanation of Benefits (EOBs), Explanation of Payments (EOPs), and Electronic Remittance Advices (ERAs).
• Strong understanding of Coordination of Benefits (COB), out-of-pocket maximums, deductibles, coinsurance, copayments, and other patient financial responsibility components.
• Proven experience interacting directly with patients and delivering exceptional customer service in a professional healthcare environment.
• Strong analytical, organizational, and problem-solving skills with attention to detail and accuracy.
• Proficiency in electronic medical record (EMR) and practice management systems preferred.