Accounts Receivable Specialist II

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

📋 Description

• Oversee intricate patient and insurance accounts receivable, with a focus on high-value, aged, and escalated accounts.

• Investigate and rectify claim denials, underpayments, billing discrepancies, and reimbursement challenges.

• Analyze trends in accounts receivable, pinpoint root causes, and propose enhancements to billing and collection processes.

• Act as a super-user for NextGen Practice Management, generating advanced reports and identifying areas for workflow optimization.

• Monitor clearinghouse activities via TriZetto, including claim rejections, submission errors, and processing complications.

• Interpret payer agreements, reimbursement protocols, and billing stipulations to ensure precise claim resolution.

• Lead special projects and initiatives for accounts receivable clean-up aimed at reducing outstanding balances and enhancing collections.

• Prepare financial reports, track key performance indicators, and communicate insights and recommendations to leadership.

• Mentor and assist AR team members by offering guidance on complex claims, appeals, and payer follow-up procedures.

• Collaborate with billing, payment posting, compliance, and other departments to enhance the efficiency of the revenue cycle.

• Provide operational support and coverage for team members as required.

⛳️ Requirements

• High school diploma or GED is mandatory; an Associate or Bachelor's degree is preferred.

• A minimum of 5 years of progressive experience in ophthalmology Revenue Cycle Management is required.

• At least 3 years of advanced accounts receivable follow-up experience in a multi-specialty or high-volume setting.

• Advanced proficiency in NextGen Practice Management, particularly in reporting and system functionalities.

• Strong working knowledge of TriZetto clearinghouse operations.

• Experience with complex payer guidelines, claim denials, appeals, and reimbursement methodologies.

• Strong Microsoft Excel skills, including pivot tables, data analysis, and reconciliation.

• Experience in leading accounts receivable projects or process improvement initiatives.

• Exceptional analytical, organizational, and problem-solving abilities.

• Strong communication skills with the capability to work independently and collaborate across departments.

• Revenue cycle or medical billing certification, such as CMBS, is preferred.

🏝️ Benefits

• Health and Dental insurance.

• 401(k) retirement plan with employer matching.

• Generous Paid Time Off (PTO) program.

• Ongoing training and professional development opportunities.

• Prospects for career advancement within our growing organization.