Accounts Receivable and Denial Management Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Examine outstanding and unbilled claim categories in the practice management system for accuracy prior to submission.

• Rectify eligibility, incorrect payer, demographic, and coding-related mistakes to ensure claims are approved on the initial submission.

• Confirm patient eligibility and verify the appropriate primary and secondary insurance.

• Follow up on claims that remain unpaid, underpaid, or are aged through payer portals and phone communications.

• Investigate denials, determine underlying causes, and submit revised claims, reconsiderations, or appeals.

• Monitor claim status and resolve issues utilizing Medicare, Availity, and UnitedHealthcare portals.

• Record all follow-up activities and next steps within the practice management system.

• Report persistent denial patterns and payer concerns to the billing manager.

• Collaborate with the practice’s in-house A/R team and achieve daily productivity goals.

• Safeguard patient information and adhere to HIPAA regulations.

• Provide support to a multi-specialty physician group located in Florida.

⛳️ Requirements

• Minimum of 2 years of experience in U.S. healthcare A/R follow-up and denial management.

• Proven experience in reviewing claims for accuracy and resolving eligibility and payer discrepancies.

• Knowledge of commercial insurance and government health plans, including Medicare.

• Proficient in using payer portals and insurance websites.

• Strong written and verbal communication skills in English.

• Exceptional attention to detail and follow-up capabilities.

• Ability to work autonomously and manage multiple patient accounts effectively.

• Reliable internet connection and an appropriate remote workspace.

• Availability during Eastern Time business hours is required.

• Experience with AdvancedMD is preferred.

• Familiarity with First Coast SPOT (Florida Medicare), Availity, and the UnitedHealthcare provider portal is preferred.

• Experience supporting internal medicine, hospitalist, wound care, or pain management practices is preferred.

• Knowledge of Florida insurance plans is preferred.

• Experience managing Medicare-heavy A/R and handling Medicare reconsiderations and redeterminations is preferred.

🏝️ Benefits

• Full-time employment.

• Remote work flexibility.

• Scheduled hours during Eastern Time business hours.

• Support for a suitable remote workspace is implied by the requirement for a proper remote setup.