Role Description Optima Dermatology is recruiting a full time RCM Accounts Receivable Specialist to join our Practice Support Center, based in Portsmouth, NH. Remote opportunities available for residents of ME, NH, MA, IN, OH, FL, NC. The Accounts Receivable Specialist is responsible for resolving aging claims, working denials, overseeing secondary claims, and collaborating closely with other revenue cycle teams to ensure timely and accurate resolution of accounts. This position also involves patient account management, requiring strong communication and critical thinking skills. Responsibilities - Claims Management (Accounts Receivable): - Review and resolve rejected claims, ensuring accuracy and meeting deadlines. - Research and validate posted payments and adjustments, correcting discrepancies as needed. - Post EOBs, payments, and adjustments as required to resolve outstanding claims. - Process correspondence to resolve open A/R balances for assigned providers, payers, and claims. - Analyze denials and underpayments to determine if appeals or other resolutions are necessary. - Identify and communicate denial and payment trends to improve billing procedures. - Collaborate with payers, EDI, and payment posting teams to address systemic issues and streamline processes. - Resubmit claims to secondary/tertiary payers as needed. - Maintain accurate logs of payer interactions and unresolved balances. - Utilize provider portals and payer resources to research and resolve claim processing issues. - Manage incoming calls from insurance companies regarding claims and requests for additional documentation to process submitted claims. - Understand and interpret insurance Explanations of Benefits (EOBs). - Patient Accounts Management: - Provide excellent customer service, assisting patients with billing inquiries, account balances, and financial responsibilities. - Manage incoming patient calls efficiently, resolving concerns, and escalating issues as needed. - Assist clinical and operational staff with patient demographics, scheduling, and referrals. - Educate patients on cost and payment options for services. - Analyze and resolve patient account billing issues through communication with patients, insurance providers, and healthcare systems. - Demonstrate effective call handling, including deescalating patients, by managing incoming patient calls via the phone queue. - Verify insurance eligibility and benefits as needed using automated eligibility systems, payer websites, and/or calls to the insurance carriers. - General and Administrative: - Keep management informed about backlogs, time availability, and unresolved concerns. - Maintain set standards, metrics, all KPIs and ensure individual and departmental goals are met. - Accurately document patient accounts and all actions taken. - Respond promptly to emails, voicemails, and assigned tasks. - Maintain a thorough understanding of the practice management system and electronic medical records (EMR). - Function as a resource to answer questions promptly and accurately. - Work as a collaborative team member within a distributed organization. - Participate in revenue cycle projects and contribute to departmental goals. - Work assigned intradepartmental and interdepartmental inquiries within a timely manner. - Follow all HIPAA guidelines and comply with annual training. - Demonstrate our values in interactions, empathy, and sensitivity towards patient/family rights. - Other duties assigned by the Supervisor, Manager, or Director. Qualifications - Minimum of 3 years in healthcare reimbursement preferred. - Knowledge of CPT and ICD-10 coding. - Familiarity with payer billing guidelines, submission, and remittance processes. - Experience with HCFA 1500 forms and Explanation of Benefits (EOBs). - Strong problem-solving, prioritization, and follow-through abilities. - Excellent interpersonal and communication skills, with a proven record of professional etiquette. - Ability to work independently in a demanding environment. - High school diploma or equivalent (knowledge of business administration and/or accounting preferred). Degree/certification or structured secondary education strongly preferred. - Strong initiative, judgment, and decision-making skills. - Ability to build rapport with patients and colleagues while maintaining empathy and sensitivity. - Collaborative collaborator within a distributed organization. - Adherence to company values, professionalism, and HIPAA compliance. Benefits - Generous health, dental, vision, disability, and life insurance.