Accounts Receivable Specialist

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

📋 Description

• Oversee the accounts receivable process for Oral Surgery insurance at HighFive.

• Accurately and promptly submit claims.

• Follow up on claims that are unpaid or denied.

• Collaborate with insurance companies, healthcare payors, and patients to address billing discrepancies and issues.

• Investigate, appeal, and resolve claims that have been denied or rejected.

• Clarify any discrepancies with insurance providers to ensure proper reimbursement.

• Review and evaluate the Explanation of Benefits (EOBs) at the individual claim level.

• Identify root causes of billing or claim submission problems and implement measures to prevent them from recurring.

• Correct and resubmit claims based on denials, following established processes and procedures.

• Pursue unresolved claims using system resources, clearinghouses, payer portals, or direct communication with payors.

• Evaluate whether appeals are necessary and monitor their progress for timely payment and resolution.

• Recognize recurring denial trends and report them to management.

• Communicate effectively with team members, payors, patients, and other relevant stakeholders.

• Stay updated on internal processes, industry standards, and government regulations pertinent to denial management.

• Engage in special projects or perform additional tasks as required.

• Meet or surpass daily account requirements.

• Achieve departmental targets for net collection rates and resolution of denied claims.

⛳️ Requirements

• Experience in Oral Surgery billing is required.

• Preference for candidates with Denial/Claim or Accounts Receivable experience related to TMJ (temporomandibular joint/orthognathic surgery).

• High school diploma or equivalent is necessary; an associate or bachelor’s degree in healthcare, business, or a related field is preferred.

• A minimum of 2 years of experience in healthcare billing and accounts receivable is required.

• Familiarity with medical insurance plans, billing procedures, and healthcare reimbursement processes is essential.

• Proficient in using Electronic Health Record (EHR) systems and billing software.

• Dental billing experience is preferred, though not mandatory.

• Basic knowledge of Excel and system workflows is necessary.

• Prior experience in a mid to large-scale healthcare business office with 100 or more providers is preferred.

• Strong attention to detail with the capability to accurately review and process claims.

• Excellent communication and problem-solving skills are required.

• Ability to work independently and manage multiple tasks concurrently is essential.

• Knowledge of HIPAA and other healthcare compliance regulations is necessary.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health and dental insurance.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork.

• Flexible working hours and potential for remote work.