Accounts Receivable Specialist

📋 Description

• • Take ownership of the complete accounts receivable (A/R) lifecycle, from initial billing and payment posting through to complex claim resolution and reconciliation.
• • Meticulously manage the end-to-end A/R workflow, ensuring accuracy and efficiency in all processes, including billing, payment posting, adjustments, reconciliation, claim follow-up, and the ultimate resolution of outstanding balances.
• • Drive the timely and accurate submission of claims across a diverse range of payer types, including commercial insurance, Medicare, Medicaid, and various managed care organizations, adhering to all specific payer requirements.
• • Perform detailed reconciliations of payments received against remittances (ERAs/EOBs), proactively identifying and correcting any posting discrepancies to maintain financial integrity.
• • Conduct in-depth investigations into denied or underpaid claims, meticulously determining the root causes of these rejections and implementing effective corrective actions to prevent recurrence.
• • Develop and submit persuasive appeal letters for denied claims, ensuring they are robustly supported by comprehensive documentation and align with current regulatory guidelines and payer policies.
• • Proactively track and analyze denial patterns and trends, identifying systemic issues that may be impacting revenue cycle performance.
• • Escalate identified systemic issues to leadership, providing clear data and insights to support recommendations for process improvements and strategic adjustments.
• • Engage directly with payer representatives via multiple communication channels (phone, email, fax, and payer portals) to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers that hinder payment.
• • Foster strong, collaborative relationships with payer representatives to enhance overall reimbursement efficiency and streamline the payment process.
• • Maintain clear, professional, and timely communication with internal teams, including billing, coding, and clinical staff, as well as external clients, providing regular updates on claim status, identified trends, and their financial implications.
• • Apply a thorough understanding of current federal and state regulations that directly impact reimbursement, with a specific focus on Medicare/Medicaid guidelines and compliance requirements.
• • Review and resolve Electronic Data Interchange (EDI) rejections, claim edits, and submission errors to ensure clean claim submission and minimize downstream issues.
• • Leverage automation tools, Robotic Process Automation (RPA) workflows, and AI-enabled processes to streamline claim follow-up activities and significantly improve overall productivity and efficiency.
• • Maintain meticulous and accurate documentation of all A/R activities, interactions, and resolutions, ensuring a clear audit trail.
• • Consistently meet or exceed established productivity and quality benchmarks, demonstrating a commitment to high performance and operational excellence.
• • Contribute to a culture of continuous improvement within the revenue cycle operations, actively seeking opportunities to enhance processes and outcomes.
• • Adapt to evolving payer rules and regulations, staying informed about changes that may affect claim submission and reimbursement strategies.
• • Utilize advanced analytical skills to identify opportunities for revenue optimization and cost reduction within the A/R function.
• • Collaborate effectively with cross-functional teams to address complex billing and reimbursement challenges, ensuring a cohesive approach to revenue cycle management.
• • Support the training and development of junior team members by sharing expertise and best practices in accounts receivable management.
• • Ensure compliance with all company policies and procedures, particularly those related to financial data security and patient privacy (HIPAA).