Overview
This role reports to the Accounts Receivable Supervisor and supports the operations of the Revenue Cycle Management (RCM) team focused on follow-up and resolution of outstanding insurance claims. The primary goal is to investigate, follow up on, and resolve claims submitted to insurance for payment, while maintaining detailed notes on the status of individual claims.
Responsibilities
- Contact insurance carriers daily to follow up on and collect past due amounts on outstanding medical claims related to denials or benefit changes.
- Maintain an accurate and up-to-date aging of assigned accounts, including accounts receivable analysis and follow-up.
- Stay informed on billing and medical policies for all payers.
- Understand in-network and out-of-network reimbursement processes and methodologies.
- Create and follow up on appeals to contest denials or incorrect payments.
- Review and resolve complex denials and tasks assigned by the payment posting team, including refund requests, disputes, and appeals.
- Collaborate across all RCM departments to resolve issues related to claims payment.
- Ensure compliance with all company policies, procedures, and regulatory requirements.
- Work with the AR Supervisor to review and resolve open accounts as assigned.
- Perform other duties as assigned.
Requirements
Education
- High School Diploma or GED.
Experience
- Minimum 3 years managing Accounts Receivable and performing direct follow-up with payers.
- At least 1 year of effective oral and written communication experience with insurance payers and internal teams.
- 3 years working knowledge of medical terminology, ICD-10, CPT, HCPCS coding, and HIPAA requirements.
- 2 years experience with data processing and analytical skills, proficiency in Excel, Microsoft Office Suite, medical practice management software, and electronic medical records.
- 3 years experience working with commercial, government, and state insurance payers and their reimbursement policies and procedures.
- 3 years experience handling complex insurance issues, including correct payer assignment, EOB adjustments, and refunds.
Skills and Abilities
- Strong relationship-building skills and commitment to excellent customer service.
- Proficient computer skills for data entry, research, and information retrieval.
- High attention to detail, accuracy, and ability to multitask.
- Advanced problem-solving capabilities.
- Professionalism and kindness when interacting with staff, payers, patients, and families.
- Ability to ensure services comply with state and federal regulations, organizational policies, and accreditation requirements.
- Ethical behavior and role modeling aligned with organizational values.
- Ability to promptly identify and report issues.
- Reliable attendance and punctuality.
- Ability to manage high volumes of work and maintain an organized schedule independently.
- Effective monitoring of claims processing steps.
Preferred Qualifications
- 1 year experience with Federally Qualified Health Center (FQHC) billing and revenue cycle activities.
- 1 year experience using EPIC PM/EMR system.
Location
Position location details are not specified.
Compensation and Benefits
Compensation details are not provided in the description.