Senior Specialist Accounts Receivable

Overview

A healthcare revenue cycle management organization is seeking a Senior Accounts Receivable Specialist to perform follow-up and denial activities related to claim payments. This role involves direct communication with commercial, governmental, and other payers to resolve payment issues, secure timely reimbursement, and manage appeals. The specialist will also mentor team members and assist leadership with projects aimed at accounts receivable reduction and cash acceleration.

Responsibilities

• Mentor Accounts Receivable (AR) Specialist team members to enhance skills in denials and appeals processes.
• Analyze denied and unpaid claims to determine reasons for discrepancies.
• Proactively resolve complex claims and recommend interventions based on identified trends.
• Communicate directly with payers to follow up on outstanding claims, file technical and clinical appeals, and resolve payment variances.
• Guide team members on complex claims resolution and appeals filing.
• Identify reasons for underpayments, denials, and payment delays; collaborate with management to address root causes.
• Take meeting minutes during payer escalation calls and provide feedback to AR associates.
• Maintain thorough knowledge of federal and state regulations and payer-specific requirements, ensuring compliant billing.
• Accurately document all activities, including contact information and relevant details, in client systems or tracking tools.
• Review escalations within AR and coordinate with other revenue cycle areas as needed.
• Assist supervisors with special calls and projects related to accounts receivable.
• Meet established productivity and quality standards.
• Perform other duties and projects as assigned.

Requirements

• Basic computer proficiency, including strong skills in Microsoft Excel.
• For internal candidates: must have met 120% productivity and 98% quality assurance standards for the previous three months.
• For external candidates: must meet quality and productivity standards by day 90; failure to do so may result in demotion.
• Excellent verbal communication skills.
• Strong problem-solving and critical thinking abilities to develop collection plans.
• Adaptability to changing procedures and a growing work environment.
• Ability to meet attendance policies and work within established timelines.
• Associate or bachelor's degree.
• At least 1 year of relevant experience in medical collections, physician/hospital operations, AR follow-up, denials and appeals, compliance, provider relations, or professional billing preferred.
• Knowledge of claims review and analysis.
• Working knowledge of revenue cycle processes.
• Certified Revenue Cycle Representative (CRCR) certification either upon hire or within 9 months.
• Experience with the DDE Medicare system and payer websites for claim status investigation.
• Familiarity with medical and insurance claim terminology.

Compensation & Benefits

• Starting pay: $18.65 per hour (final compensation based on experience).
• Bonus incentives.
• Paid certifications.
• Tuition reimbursement.
• Comprehensive benefits package supporting physical, emotional, and financial health.
• Career advancement opportunities.

Location

• Not specified.

This role requires strong analytical skills, attention to detail, and the ability to work collaboratively within a team to ensure timely and accurate reimbursement for healthcare services. The organization is an equal opportunity employer and provides reasonable accommodations for qualified individuals with disabilities.