Overview
A technology-driven national physician enablement organization is seeking an Accounts Receivable (AR) Case Management Specialist to support revenue cycle management. This role focuses on ensuring accurate and timely processing of claims concerns and projects, acting as a liaison between financial accuracy and communication to resolve insurance claim denials.
Responsibilities
- Manage the full lifecycle of Salesforce cases related to revenue cycle management (RCM), ensuring inquiries are documented, categorized, and resolved within established Service Level Agreements (SLAs).
- Monitor Salesforce dashboards to identify trends in practice inquiries and report case resolution efficiency to leadership.
- Apply deep expertise in billing, accounts receivable follow-up, and denial management to promote one-touch resolution of escalated cases.
- Make independent decisions regarding claim adjustments, resubmissions, and advanced resolution techniques in line with company policies and best practices.
- Collaborate with internal teams and care center staff to streamline workflows and resolve escalated billing issues.
- Utilize Trizetto software to perform denial analysis and initiate requests to add rules or edits to prevent recurring errors.
- Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality and drive department Key Performance Indicators (KPIs).
- Perform other duties as assigned.
Requirements
- High school diploma or equivalent.
- Minimum of 3 years of experience in a medical billing office or equivalent claims experience.
- Advanced Microsoft Excel skills preferred (e.g., pivot tables, VLOOKUP, formulas).
- Experience with athenaHealth/athenaOne and Salesforce Case Management is highly preferred.
- Strong understanding of credentialing and enrollment as it relates to claims processing.
- Ability to understand revenue cycle performance drivers and resolve complex, multi-layered claim issues.
- Strict compliance with HIPAA rules, regulations, and company policies regarding information privacy.
Compensation & Benefits
- Base salary range: $52,000 to $55,000 annually, exclusive of bonuses and benefits.
- Eligible for an annual bonus targeted at 10%.
- Benefits include medical, dental, vision, life, and pet insurance, 401(k), paid time off, and wellness programs.
- Base pay will be determined based on experience, education, and geographic location.
Additional Information
- All applicant information will be kept confidential in accordance with Equal Employment Opportunity guidelines.
Technical Requirements (for remote workers only)
- Minimum internet speed of 5 Mbps download and 3 Mbps upload required prior to employment.
- Employees working from home offices may be eligible for expense reimbursement related to internet costs.
Location
- This role may be remote or onsite depending on organizational needs.