Accounts Receivable Specialist - Medical Claims

The Accounts Receivable Specialist ensures accurate, compliant, timely billing and appropriate reimbursement for multispecialty medical professional services from various insurance payers and patients.

This includes correct and timely collection of unpaid patient accounts with goals to be met, re-billing, payment posting, contractual write-offs, adjustments, appeals per multi-state and federal insurance regulations for patients receiving services with our clients.

Duties and Responsibilities:

• Prepare and re-submit clean claims to various insurance companies either electronically or by paper in accordance with specific payer guidelines and/or contract requirements.
• Analyze and correct first pass rejected claims for completeness and accuracy of information for second pass clean claim submission.
• Research and perform all primary and secondary billing claim status follow up activities for assigned insurance plans.
• Review, evaluate, and process all claim appeals through resubmission to insurance carriers with complete and accurate supporting documentation required.
• Research and recommend any customer account adjustments and/or write-offs to the Manager based upon collectability of account with insurance carrier or patient.
• Recognize and report claims problems, errors, and discrepancies to management in order to proactively identify and effectively resolve billing trends in a timely manner.
• Generate and submit monthly patient balance due statements to customers as dictated by the explanation of benefits received from their insurance carrier.
• Reviewing patient accounts, identifying delinquent accounts, and collecting overdue payments.
• Answering patient questions about billing and payments.
• Investigating and/or directing patient inquiries or complaints to the appropriate staff member.

Position Proficiencies and Requirements:

• A High School Diploma, GED, or equivalent work experience.
• Experience in Medical Insurance Claims billing preferred.
• Minimum of 7 years of experience required.
• Proficient in Microsoft Office (Outlook, Excel, Word) and Google applications.
• Proactive curiosity and basic AI fluency to identify efficiency gains and streamline daily workflows in a fast-paced setting.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to define problems, collect data, establish facts, and identify trends.
• Ability to exercise good judgment and escalate issues appropriately.

Competencies to Drive Success:

• Strong written and verbal communication skills; a self-starter who is dependable and reliable.
• Must work well within a team structure, possessing outstanding interpersonal relationship skills, as well as the ability to work independently.
• Strong organizational skills and detail-oriented with the ability to prioritize, complete tasks, and meet deadlines.
• Must be able to promote a positive influence within the team, department, and company.
• Ensure and adhere to departmental compliance with HIPAA guidelines, Raintree Systems, Inc. HR policies, standard operating procedures, and other corporate initiatives.