Accounts Receivable Specialist

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

📋 Description

• Input and verify charges for accuracy, ensuring adherence to coding standards and compliance with payer requirements.

• Leverage the charge router within Epic to efficiently and accurately direct charges to the appropriate claim workflows.

• Detect and rectify charge capture errors or inconsistencies to avert billing delays.

• Prepare, review, and submit electronic and paper claims through Epic and various clearinghouses.

• Apply claim form logic to evaluate and address formatting errors prior to submission.

• Collaborate with insurance companies to resolve discrepancies, missing documents, and claim rejections.

• Analyze UB-04 and CMS-1500 claim form logic to ensure adherence to proper billing practices.

• Monitor claims for timely submissions and manage any rejected or denied claims.

• Assist in managing accounts receivable by identifying patterns in denials or delays.

• Conduct payer appeals on denied claims as necessary.

• Support billing workflows, payment posting, and reporting utilizing Epic and other EHR systems.

• Reconcile daily payment batches and resolve any discrepancies.

• Monitor unapplied payments and correct posting errors.

• Collaborate with banking institutions regarding deposit processing and handling returned or rejected transactions.

• Address inquiries related to payment posting and ERA processes.

• Generate and analyze reports on payment posting and cash reconciliation.

• Maintain patient accounts and payer information accurately.

• Work alongside IT and billing teams to address system-related billing issues.

• Ensure compliance with FQHC guidelines, Massachusetts healthcare regulations, and payer rules.

• Stay informed about coding guidelines, billing codes, payer policies, and industry best practices.

• Participate in both internal and external audits.

• Collaborate with clinical, coding, and health information teams to resolve documentation challenges.

• Address billing inquiries from insurance companies, patients, and other stakeholders.

• Review billing dashboards to track performance metrics and denial trends.

• Provide feedback to leadership on workflow improvements.

• Deliver customer service for account inquiries and payment-related concerns.

• Perform additional duties as assigned.

⛳️ Requirements

• At least 3-5 years of experience in medical billing, ideally in an FQHC or professional billing environment.

• Familiarity with Massachusetts healthcare billing regulations and payer requirements.

• Proficient in Epic resolute professional billing processes.

• Strong understanding of claim form logic and payer-specific billing standards.

• Knowledgeable about Massachusetts healthcare regulations and insurance processes.

• Proficient in medical coding (CPT, ICD-10, HCPCS) and compliance mandates.

• Exceptional attention to detail, organizational abilities, and the capacity to meet deadlines.

• Strong communication and problem-solving capabilities.

• Effective communication skills across various stakeholders, demonstrating diligence and problem-solving expertise.

• Experience with Microsoft Office Suite.

• A strong commitment to quality assurance and outstanding customer service.

• A deep commitment to C3’s mission.

• A high school diploma or equivalent is required.

• An associate or bachelor’s degree in business, healthcare administration, or a related field is preferred.

• Familiarity with the MassHealth ACO program.

• Experience working in Federally Qualified Health Centers (FQHC) is a plus.

• Experience with anti-racism initiatives and/or personal experience with racism is highly preferred.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance plans.

• Generous paid time off and holidays.

• Retirement savings plan with employer matching.

• Professional development opportunities and training programs.

• Supportive work environment with a focus on team collaboration.