Accounts Receivable & Case Management Specialist

Overview

A national, technology-driven physician enablement organization is seeking an Accounts Receivable & Case Management Specialist. The organization partners with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences by supporting doctors in delivering high-value care through both in-person and virtual settings. Their platform leverages scalable operations and cloud-based technology to reduce healthcare costs, improve outcomes, and enhance the well-being of patients and providers.

Responsibilities

• Manage the full cycle of Salesforce cases related to revenue cycle management inquiries, ensuring documentation and resolution within Service Level Agreements (SLAs).
• Monitor Salesforce dashboards to identify trend patterns and report case resolution efficiency to leadership.
• Utilize expertise in billing, accounts receivable follow-up, and denial management to resolve escalated cases efficiently.
• Make independent decisions on claim adjustments, resubmissions, and advanced resolution techniques in accordance with policies and best practices.
• Collaborate with internal teams and care center staff to streamline workflows and resolve billing issues.
• Use Trizetto to perform denial analysis and request rule or edit updates to prevent recurring errors.
• Work with practice consultants or physicians to optimize revenue cycle functionality and drive department Key Performance Indicators (KPIs).
• Perform additional duties as assigned.

Requirements

• High School Graduate.
• Minimum of 3 years’ experience in a medical billing office or equivalent claims experience.
• Advanced Microsoft Excel skills preferred (pivot tables, VLOOKUP, formulas).
• Experience with athenaHealth/athenaOne and Salesforce Case Management highly preferred.
• Strong understanding of credentialing and enrollment related to claims processing.
• Ability to understand revenue cycle drivers and resolve complex claim issues.
• Strict compliance with HIPAA rules and company policies regarding information privacy.

Compensation & Benefits

• Salary range: $52,000 to $55,000 base pay, excluding bonus and benefits.
• Eligible for an annual bonus targeted at 10%.
• Base pay determination considers experience, education, and geographic location.

Equal Opportunity

The employer is an equal opportunity organization committed to diversity and inclusion. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.