Specialist, Accounts Receivable

Duties and Responsibilities

• Follow-up and collect on accounts in assigned inventory.
• Utilize experience and follow-up strategies and tools to resolve claims and obtain payment.
• Escalate unpaid claims to payer claims supervisor when regular follow-up efforts are not successful.
• Document client’s host system using the 5 W’s framework and related policies/procedures to ensure accurate and complete documentation, then copy account notes into Amplify’s workflow tool.
• Assign appropriate status codes in Amplify’s workflow tool to identify and address trends.
• Write first and second level appeals of all denials to overturn and secure payment.
• Escalate payer denial and other trends to Management for further assistance.
• May also work assigned underpayments as directed by Management.
• Maintain daily productivity and quality expectations for assigned accounts.
• Research and analyze correspondence received related to assigned accounts.

Knowledge, Skills, and Abilities

• Adaptability and ability to work independently in a fast-paced, changing, and goal-oriented environment.
• Direct account follow-up and/or billing experience.
• Medical Terminology, ICD-10, CPT, and DRG knowledge (preferred).
• Intermediate experience in Excel (preferred).
• Ability to provide information regarding patient accounts in response to inquiries, safeguarding confidential information.
• Understanding of the entire revenue cycle.
• Detail orientation, organization, and critical thinking skills.
• Problem-solving, inquiry, and customer interaction abilities to ensure positive results.

Work Experience, Education, and Certifications

• High school diploma or equivalent.
• Additional training in hospital insurance collections is a plus.
• 3-5 years of collections experience in a Hospital Business Office.

Working Conditions and Physical Requirements

• Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment.
• The ability to communicate daily with team members, management, and clients through email, phone calls, video meetings, and other collaborative tools.
• Primarily requires sitting at a desk for extended periods.
• Must have access to reliable high-speed internet with sufficient bandwidth for video conferencing, cloud-based tools, and other online work-related activities.
• A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.