RCM Accounts Receivable Specialist- Medical Billing Experience

Netsmart is an equal opportunity workplace and affirmative action employer, committed to diversity and inclusion.

About the Role

The RCM Accounts Receivable Specialist resolves 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.

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 RPA tools and AI-assisted workflows to enhance efficiency, automate routine follow-up activities, and improve claim resolution outcomes.
• Maintain detailed documentation of account activity and claim resolution efforts.

Requirements

• High school diploma or GED.
• Minimum of 1 year of healthcare accounts receivable, medical billing, or denial management experience.
• Demonstrated experience researching and resolving insurance claim denials and payer reimbursement issues.
• Advanced Microsoft Excel skills, including VLOOKUPs/XLOOKUPs, Pivot Tables, filters, formulas, and spreadsheet management.
• Strong proficiency in Microsoft Outlook, including managing high-volume email communications and claim follow-up correspondence.
• Understanding of insurance reimbursement processes, claim adjudication, Medicare, Medicaid, and commercial payer requirements.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent verbal and written communication skills.
• Demonstrated ability to manage productivity metrics and work independently in a fast-paced environment.

Preferred Qualifications

• Experience in behavioral health, post-acute care, home health, long-term care, or specialty healthcare billing.
• 2+ years of insurance AR follow-up and denial management experience.
• Collections experience within a healthcare revenue cycle environment.
• Experience preparing and submitting formal appeals to insurance carriers.
• Working knowledge of medical billing systems such as Medic, IDX, Avatar, Tier, Medical Manager, or similar platforms.
• Experience with automation tools, AI-enabled workflows, or revenue cycle technology solutions.

All post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen. If a candidate tests positive for a controlled substance, the offer of employment will be rescinded unless valid proof of prescription is provided.