Accounts Receivable (A/R) Specialist - Medical Billing

Position Summary

The A/R Specialist is responsible for managing accounts receivable (A/R), reviewing and correcting denied or rejected claims, and ensuring timely follow-up with insurance carriers. This role requires strong knowledge of healthcare payer guidelines, claim workflows, and primary care billing practices.

Responsibilities

Claims Management

• Follow up on insurance claims to ensure timely and accurate payment.
• Review, research, and correct denied or rejected claims; resubmit as necessary.
• Communicate with insurance carriers to resolve claim issues and discrepancies.
• Work claims through final resolution, not just follow-up activity, ensuring appropriate reimbursement or adjustment.
• Independently research and resolve complex claim denials, including medical necessity, coding-related denials, appeals, and payer escalations.
• Identify payer trends and provide feedback to management.
• Identify recurring denial patterns and provide feedback to management on opportunities to prevent future denials.
• Navigate insurance portals to verify claim status, eligibility, and payer notes.
• Maintain accurate and detailed documentation of all claim activity, denials, appeals, and adjustments.
• Identify and escalate credentialing or contracting issues.

Denials & Follow-Up

• Maintain an organized follow-up bucket with accurate claim status and next actions.
• Review and resolve daily denials assigned by remit code per payer and company guidelines, including:
• Bundled or Non-Covered Services
• Lack of Medical Necessity
• Insurance Eligibility / Demographic Issues
• Out-of-Network / Credentialing
• Modifiers, POS, CLIA #
• Manage and aggressively work aging A/R balances, including claims exceeding 90 and 120 days, to ensure timely resolution and payment.
• Analyze recurring denial trends and collaborate with internal teams to identify root causes and reduce repeat denials.

Qualifications

• Minimum 3-5 years of experience in medical billing, denials management, and A/R follow-up, preferably with experience handling complex A/R accounts and denials.
• Primary Care (PCP) billing experience preferred.
• Demonstrated experience independently researching and resolving complex denials, appeals, and payer escalations.
• Experience managing aging accounts receivable, including claims aged 90+ and 120+ days.
• Strong understanding of EOBs, ERAs, payer rules, denial resolution strategies, and revenue cycle processes.
• Experience working with claim management and EHR systems.
• Experience with eClinicalWorks (eCW) is preferred.
• Excellent communication, organization, analytical, and problem-solving skills.