Accounts Receivable & Denial Management Specialist

Accounts Receivable & Claims Resolution Specialist

The Accounts Receivable & Claims Resolution Specialist is responsible for managing insurance receivables, resolving claim denials, maximizing reimbursement recovery, and supporting overall revenue cycle performance. This role requires strong analytical skills, attention to detail, and proactive communication with payers, providers, patients, and internal teams to ensure timely claim resolution and payment accuracy.

Key ResponsibilitiesAccounts Receivable & Denial Management

• Monitor and manage outstanding insurance claims to support the reduction of Accounts Receivable (AR) balances and improve cash flow performance.
• Perform ongoing follow-up on denied, rejected, or unpaid claims to secure timely resolution and maximize reimbursement opportunities.
• Analyze Electronic Remittance Advice (ERA) reports to identify denial trends, recurring issues, and opportunities for process improvement.
• Prepare, submit, and track claim appeals, ensuring all supporting documentation is complete, accurate, and submitted within payer deadlines.
• Investigate payment discrepancies, underpayments, and unresolved claim issues, escalating complex matters when necessary.
• Maintain accurate AR aging reports and provide regular performance updates, including weekly and monthly status reports.
• Manage billing and reimbursement activities for specialized services such as TMS, Spravato, and psychological assessments.
• Collaborate with leadership to achieve departmental goals related to AR reduction, reimbursement accuracy, and revenue recovery.

Patient, Provider & Payer Relations

• Respond promptly and professionally to billing-related inquiries from patients, providers, insurance payers, and internal departments.
• Review and validate patient account information before initiating collection efforts or claim follow-up activities.
• Partner with healthcare providers to resolve claim issues involving coding errors, missing documentation, or incomplete records.
• Communicate directly with insurance carriers regarding eligibility verification, prior authorizations, claim status updates, and provider network participation.
• Address patient billing concerns with professionalism and empathy, including the processing of account adjustments and refunds when appropriate.

Systems Management & Operational Excellence

• Create, monitor, and resolve billing-related support tickets within eClinicalWorks (eCW) and other revenue cycle platforms.
• Provide guidance and support to team members regarding denial management, appeals, and AR follow-up best practices.
• Coordinate closely with U.S.-based billing teams to ensure accurate claim submission, processing, and reimbursement tracking.
• Participate in operational and performance review meetings to evaluate key metrics, identify trends, and recommend workflow enhancements.
• Stay current with payer policies, regulatory requirements, industry standards, and reimbursement guidelines to ensure ongoing compliance and operational effectiveness.

Core Competencies

• Extensive knowledge of medical billing, accounts receivable management, and denial resolution processes.
• Strong understanding of insurance claims, appeals, reimbursement methodologies, and payer requirements.
• Excellent analytical, problem-solving, and investigative skills.
• Effective communication and relationship-building abilities with patients, providers, and insurance representatives.
• Proficiency in eClinicalWorks (eCW), ERA analysis, practice management systems, and revenue cycle reporting.
• Ability to manage multiple priorities while maintaining accuracy and meeting performance goals.

Pay: Rs40,000.00 - Rs70,000.00 per month

Ability to commute/relocate:

• Wapda Town: Reliably commute or planning to relocate before starting work (Preferred)

Application Question(s):

• Willing to work the night shift at Wapda Town, Lahore

Experience:

• Medical Billing: 1 year (Preferred)

Language:

• English (Preferred)

Work Location: In person