Accounts Receivable Specialist – Medical Billing Experience

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

📋 Description

• Oversee a portfolio of outstanding insurance accounts receivable, ensuring prompt follow-up and resolution of unpaid or underpaid claims.

• Execute comprehensive denial management, including investigating claim denials, determining root causes, submitting appeals, and obtaining appropriate reimbursement.

• Assess denial patterns and reimbursement trends to pinpoint opportunities for process enhancement and revenue recovery.

• Communicate with insurance carriers through phone, email, fax, payer portals, and written correspondence to address claim issues and payment delays.

• Investigate and rectify claim edits, rejections, authorization challenges, coding discrepancies, and payer-specific reimbursement issues.

• Follow up on aged accounts and claims that have not received responses from insurance carriers while upholding productivity and quality standards.

• Utilize Microsoft Excel to monitor accounts, analyze payer trends, manage work queues, generate reports, and keep denial inventories updated.

• Employ Microsoft Outlook extensively for communication with payers, clients, and internal team members regarding claim resolution activities.

• Review and adhere to current federal, state, Medicare, Medicaid, and payer-specific billing regulations.

• Manage Electronic Data Interchange (EDI) transactions, including the reconciliation of carrier submissions, clearinghouse edits, and rejection reports.

• Utilize RPA tools and AI-assisted workflows to improve efficiency, automate routine follow-up tasks, and enhance claim resolution outcomes.

• Maintain thorough documentation of account activities and efforts in claim resolution.

⛳️ Requirements

• High school diploma or GED.

• At least 1 year of experience in healthcare accounts receivable, medical billing, or denial management.

• Proven experience in researching and resolving insurance claim denials and payer reimbursement challenges.

• Advanced skills in Microsoft Excel, including VLOOKUPs/XLOOKUPs, Pivot Tables, filters, formulas, and spreadsheet management.

• Strong proficiency in Microsoft Outlook, particularly in handling high-volume email communications and claim follow-up correspondence.

• Knowledge of insurance reimbursement processes, claim adjudication, as well as Medicare, Medicaid, and commercial payer requirements.

• Excellent analytical, critical thinking, and problem-solving abilities.

• Outstanding verbal and written communication skills.

• Proven capability to manage productivity metrics and work autonomously in a fast-paced environment.

• All applicants must be legally authorized to work in the United States.

• Netsmart does not offer work visa sponsorship for this position.

• Preferred: Experience in behavioral health, post-acute care, home health, long-term care, or specialty healthcare billing.

• Preferred: Over 2 years of experience in insurance AR follow-up and denial management.

• Preferred: Experience in collections within a healthcare revenue cycle environment.

• Preferred: Familiarity with preparing and submitting formal appeals to insurance carriers.

• Preferred: Working knowledge of medical billing systems such as Medic, IDX, Avatar, Tier, Medical Manager, or similar platforms.

• Preferred: Experience with automation tools, AI-enabled workflows, or revenue cycle technology solutions.

🏝️ Benefits

• Equal employment and advancement opportunities.

• Pre-employment background check and drug screen provided at Netsmart’s sole expense.