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, addressing unpaid or underpaid claims.

• Conduct comprehensive denial management, which includes researching denials, pinpointing root causes, submitting appeals, and securing reimbursements.

• Evaluate denial trends and reimbursement patterns to discover process enhancements and opportunities for revenue recovery.

• Communicate with insurance carriers via phone, email, fax, payer portals, and written correspondence.

• Examine and resolve issues related to claim edits, rejections, authorizations, coding inconsistencies, and payer-specific reimbursement concerns.

• Follow up on aged accounts and claims lacking carrier responses, while upholding productivity and quality standards.

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

• Leverage Microsoft Outlook for extensive communication with payers, clients, and internal stakeholders.

• Review and implement federal, state, Medicare, Medicaid, and payer-specific billing regulations.

• Manage EDI transactions, including carrier submission reconciliation, clearinghouse edits, and rejection reports.

• Employ RPA tools and AI-assisted workflows to automate routine follow-ups and enhance claim resolution.

• Keep thorough documentation of account activities and claim resolution efforts.

⛳️ Requirements

• High school diploma or GED required.

• 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 issues.

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

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

• Knowledge of insurance reimbursement processes, claim adjudication, 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 independently in a fast-paced environment.

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

• Must successfully pass a pre-employment background check, including a drug screening.

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

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

• Preferred: Collections experience within a healthcare revenue cycle environment.

• Preferred: Experience in preparing and submitting formal appeals to insurance carriers.

• Preferred: Familiarity with 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 screening provided at Netsmart’s sole expense.