Specialist, Accounts Receivable

Overview

This role involves following up with insurance payers on outstanding claims to resolve obstacles to payment and accelerate cash collections. The position supports independent hospitals and healthcare providers by managing accounts receivable and ensuring timely reimbursement.

Responsibilities

• Follow up and collect on accounts in assigned inventory using experience and strategic tools to resolve claims and obtain payment.
• Escalate unpaid claims to payer claims supervisors when regular follow-up efforts are unsuccessful.
• Document client host system information using the 5 W’s framework and related policies/procedures, then transfer account notes into the workflow tool.
• Assign appropriate status codes (e.g., root cause, action) in the workflow tool to identify and address trends.
• Write first and second level appeals for denials to overturn and secure payment.
• Escalate payer denial trends and other issues to management for further assistance.
• Work on assigned underpayments as directed by management.
• Maintain client and position-specific daily productivity and quality expectations.
• Research and analyze correspondence related to assigned accounts.

Requirements

• Ability to work independently from home in a fast-paced, changing, and goal-oriented environment.
• Direct account follow-up and/or billing experience.
• Knowledge of medical terminology, ICD-10, CPT, and DRG preferred.
• Intermediate Excel skills preferred.
• Understanding of the entire revenue cycle.
• Detail-oriented, organized, and able to apply critical thinking skills.
• Experience assisting with problem solving, inquiries, and customer interaction to ensure positive results.
• Safeguard confidential patient information in verbal and written communications.

Experience and Education

• High school diploma or equivalent required.
• Additional training in hospital insurance collections is a plus.
• 3-5 years of collections experience in a hospital business office.

Working Conditions

• Remote work from home with a stable internet connection.
• Quiet, dedicated workspace free of distractions.
• Access to necessary office equipment.
• Daily communication with team members, management, and clients via email, phone, video meetings, and other collaborative tools.
• Primarily desk-based work requiring proper lighting and ergonomics.
• Reliable high-speed internet connection required.
• Access to stable Wi-Fi with sufficient bandwidth for video conferencing and cloud-based tools.
• HIPAA-compliant work environment required, including secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.

Travel

• None

Location

• Remote (work from home)