P36073 Accounts Receivable Specialist - RCM (Unfilled)

Overview

The Accounts Receivable Specialist – Revenue Cycle Management (RCM) is responsible for collecting outstanding accounts receivable from third-party payers, including both government and commercial entities. This role involves managing various projects assigned by management, anticipating and responding to a wide range of issues, and independently assisting in creating and maintaining documentation of key processes.

Note: Candidates residing in California, Hawaii, or Alaska are not eligible for this position.

Responsibilities

• Perform advanced-level denial management tasks.
• Process and follow up on all types of appeals at an expert level for all payers.
• Take actionable steps to resolve open claims, including refiling, appealing claims, or resolving manual tasks assigned to accounts receivable for review.
• Manage outstanding accounts receivable from assigned projects.
• Serve as a subject matter expert (SME) across multiple workflows and various payers.
• Provide peer training on payer policies and system use.
• Identify denial patterns and escalate issues to management for follow-up or root cause resolution.
• Recommend improvements to work queues and claim edits to enhance efficiency and reduce denials.
• Review payer communications related to changes in medical and reimbursement policies.
• Research payer trends identified by offshore partners and recommend training or process improvements.
• Identify opportunities for and actively participate in process improvement initiatives.
• Maintain strict confidentiality.
• Maintain proficiency in using spreadsheets.
• Meet productivity and quality standards established by the revenue cycle management team.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent required; associate or bachelor’s degree in business administration or related field preferred.
• Minimum of 3 years of accounts receivable experience preferred.
• Excellent verbal and written communication skills.
• Basic math skills for calculating anesthesia units, reimbursement, and adjustment percentages.
• General understanding of medical terminology.
• Advanced knowledge of insurance processing, payer policies, guidelines, and explanation of benefits (EOBs).
• Knowledge of commercial payer, Medicare, and Medicaid guidelines.
• High accuracy in data entry.
• General knowledge of CPT, ICD-10, and ASA codes.
• Strong problem-solving and decision-making abilities.
• Strong analytical skills and attention to detail.
• Ability to work effectively with team members, physicians, external vendors, and patients.
• Ability to work independently with limited supervision.
• Proficiency with computer applications including MS Word, MS Excel, MS Outlook, and MS Teams.
• Ability to work in a virtual team environment.

Physical Demands

• Occasional standing and walking.
• Frequent sitting.
• Frequent hand and finger movement.
• Use of office equipment (in-office or remote).
• Ability to communicate verbally and in writing.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation and Benefits

• Base pay range: $18.17 to $29.04 per hour, depending on skills, experience, and qualifications.
• Position is eligible for a quarterly bonus based on company and individual performance (bonuses are not guaranteed).

Equal Opportunity

The employer provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, parental status, national origin, age, disability, family medical history, genetic information, political affiliation, military service, or other non-merit factors.