Accounts Receivable Specialist

POSITION SUMMARY:

The accounts receivable specialist will be responsible for maintaining the organization's financial health, with a focus on timely and accurate resolution of outstanding medical claims. The accounts receivable specialist is required to have a deep understanding of the medical billing lifecycle, advanced knowledge or payer guidelines, and a proven ability to reduce accounts receivable aging through proactive follow up and denial management.

ESSENTIAL FUNCTIONS:

• Pre-claim Eligibility and Benefits: Verify patient insurance eligibility and benefits before claim submission
• Clearinghouse Rejections: Review and analyze clearinghouse rejections and identify root causes for rejected claims.
• Claims Management: Monitor and follow up on unpaid and denied medical claims across a variety of payers (Commercial, Medicare, Medicaid, Workers Comp Carriers, etc.) to ensure timely reimbursement.
• Denial Resolution: Research, analyze, and resolve claim denials and underpayments by identifying root causes, correcting errors, submitting appeals, or providing additional documentation as needed.
• Account Reconciliation: Reconcile accounts receivable by posting adjustments and resolving discrepancies to maintain accurate financial records.
• Trend Analysis & Reporting: Generate and analyze A/R reports to identify patterns in denials, reimbursement delays, or system inefficiencies, and recommend process improvements.
• Collaboration: Partner with billing, coding, and compliance teams to ensure claims are processed accurately and efficiently.
• Compliance: Maintain strict adherence to HIPAA regulations, payer-specific guidelines, and company policies to ensure data integrity and patient confidentiality
• Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
• Performs other related duties as assigned or described in Company policy.

ESSENTIAL SKILLS AND EXPERIENCE:

Education: Minimum of High School diploma or equivalent.

Experience: Minimum of 5 years of experience in medical billing or accounts receivable with a strong emphasis on insurance claim resolution and denial management.

Knowledge: In-depth understanding of medical billing and coding principles (CPT, ICD-10, HCPCS) and payer reimbursement methodologies.

Technical Skills: Proficiency with medical billing software; experience with NextGen Billing strongly preferred. Waystar Clearinghouse expertise required.

Analytical Skills: Strong ability to interpret EOBs, remittance advice, and payer correspondence to resolve complex claim issues.

Attention to Detail: Exceptional accuracy in data entry, financial reconciliation, and documentation.

Communication Skills: Effective written and verbal communication skills to interact with payers, internal teams, and external stakeholders in a professional manner.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands:

While performing the essential functions of this job, the employee is occasionally required to stand; walk; sit; lift; carry; use hands to handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop; kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds.

Work Environment:

While performing the essential functions of this job, the employee comes in contact with patient in a wide variety of circumstances. The employee may be exposed to unpleasant situations including accidents, injuries, illnesses, patient elements and varying or unpredictable situations.