Accounts Receivable Specialist – Oral Surgery

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

📋 Description

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

• Collaborate with insurance companies to clarify discrepancies and ensure appropriate reimbursement.

• Review and evaluate Explanation of Benefits (EOBs) at the claim level to identify issues.

• Identify the root cause of any billing-related or claim submission problems to prevent future occurrences.

• Amend claims based on denials and resubmit using standardized processes and procedures.

• Follow up on unresolved claims through system resources, clearinghouses, payer portals, or by contacting the payor when necessary.

• Assess whether an appeal is necessary for a denied claim.

• Monitor appeals to ensure timely resolution and payment.

• Identify recurring denial patterns and report them to management for further analysis and action.

• Communicate effectively both verbally and in writing with team members, payors, patients, and other relevant parties.

• Stay informed about internal processes, industry standards, and government regulations related to denial management to ensure compliance and best practices.

• Participate in or undertake special projects or additional responsibilities as required by the team or management.

• Meet or exceed the required accounts processed per day to fulfill HighFive and provider expectations.

• Achieve departmental objectives for net collection rates and the resolution of denied claims, including those that are successfully paid or overturned.

⛳️ Requirements

• Experience in oral surgery billing is required.

• Experience with denial/claim or accounts receivable in relation to TMJ (temporomandibular joint/orthognathic surgery).

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

• At least 2 years of experience in healthcare billing and accounts receivable is necessary.

• 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 but not mandatory.

• Working knowledge of Excel and system workflows is required.

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

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

• Excellent communication and problem-solving abilities.

• Ability to work independently and manage multiple tasks at the same time.

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

🏝️ Benefits

• Competitive salary with performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Opportunities for professional development and continuing education.

• Flexible work schedules and remote work options.

• Supportive work environment with a focus on teamwork and collaboration.