Job Description
Job Description
Position Summary
We are seeking an experienced Accounts Receivable (AR) Specialist to join our healthcare billing team. The ideal candidate will have experience in insurance follow-up, reimbursement analysis, denial resolution, and payer appeals. This role requires working knowledge of Medicare, Medi-Cal, commercial insurance, and Workers’ Compensation reimbursement while maintaining accurate account documentation and timely account follow-up.
The successful candidate will independently review accounts, identify reimbursement discrepancies, analyze payer adjudications, determine appropriate follow-up actions, and prepare appeals or reconsiderations when warranted. Strong analytical skills, attention to detail, sound judgment, and the ability to manage multiple priorities are essential for success in this role.
Primary Responsibilities
· Review insurance claims to verify payment accuracy, reimbursement methodology, and contractual compliance.
· Follow up on unpaid, underpaid, partially paid, and denied claims.
· Research payer policies, reimbursement methodologies, contractual provisions, and coverage guidelines to support claim resolution.
· Prepare appeals, reconsiderations, corrected claims, and written payer correspondence supported by reimbursement analysis and appropriate documentation.
· Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and payer correspondence to identify reimbursement issues and determine appropriate follow-up actions.
· Work with Medicare, Medi-Cal, commercial insurance, and Workers’ Compensation payers.
· Identify reimbursement trends, recurring denial patterns, and systemic issues requiring escalation or process improvement.
· Maintain complete, accurate, and timely account documentation and follow-up notes.
· Prioritize accounts based on aging reports, timely filing requirements, and payer deadlines.
· Collaborate with billing, coding, and management to resolve reimbursement issues and improve claim resolution.
Qualifications
· Minimum of 2–3 years of healthcare Accounts Receivable experience.
· Experience with insurance follow-up, reimbursement analysis, denial resolution, and payer appeals.
· Working knowledge of Medicare, Medi-Cal, commercial insurance, and Workers’ Compensation reimbursement.
· Ability to interpret Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), payer correspondence, payer policies, and reimbursement methodologies.
· Strong understanding of healthcare reimbursement processes and insurance claim follow-up.
· Excellent analytical, organizational, and problem-solving skills.
· Proficiency with Microsoft Excel and healthcare billing software.
· Excellent written and verbal communication skills.
· Experience with professional physician billing is preferred.
\nCompany Description
Medical Billing Company
Company Description
Medical Billing Company