Overview
A leading provider of technology-enabled revenue cycle management solutions for health systems is seeking a Senior Accounts Receivable Specialist. This role involves managing follow-up and denial activities related to commercial, governmental, and other payers to resolve claim payment issues and secure timely reimbursement. The position includes mentoring team members, identifying trends in denied payments, and assisting leadership with projects aimed at accounts receivable reduction and cash acceleration.
Responsibilities
- Mentor Accounts Receivable (AR) Specialist team members to improve skills in denials and appeals processes.
- Examine denied and unpaid claims to determine reasons for discrepancies.
- Resolve complex claims proactively and recommend interventions to management.
- Communicate directly with payers to follow up on outstanding claims, file technical and clinical appeals, and resolve payment variances.
- Provide guidance to team members on complex claims and appeals.
- Identify reasons for underpayments, denials, and payment delays; collaborate with management to address root causes.
- Take meeting minutes during payer escalation calls and share key takeaways with AR associates.
- Maintain thorough knowledge of federal and state regulations and payer-specific requirements.
- Accurately document all activities including contact information and relevant details in client systems.
- Review escalations within AR and coordinate with other revenue cycle areas as needed.
- Assist supervisors with DIBS calls and other special projects.
- Meet established productivity and quality standards.
- Perform other duties as assigned.
Requirements
- Basic computer proficiency, including Microsoft Excel.
- For internal candidates: must have met 120% productivity and 98% quality assurance for the previous 3 months.
- For external candidates: must meet quality and productivity standards by day 90; failure results in demotion with eligibility to reapply after 90 days.
- Excellent verbal communication skills.
- Strong problem-solving and critical thinking abilities.
- Adaptability to changing procedures and a growing environment.
- Ability to meet attendance policies.
- 2- or 4-year college 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.
- CRCR certification either upon hire or within 9 months.
- Experience with DDE Medicare system and payer websites for claim status investigation.
- Working knowledge of 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 efficient revenue cycle management and timely reimbursement.