Innovation in Revenue Cycle Management
Accounts Receivable Specialist
Location
United States
Posted
1 day ago
Salary
$17 - $19 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Accounts Receivable Specialist
Ensemble Health Partners
Role Description The Accounts Receivable Specialist is responsible for following up directly with commercial, governmental, and other payers to resolve claim payment issues, to secure appropriate and timely reimbursement and response. Identifies and analyzes denials, payment variances, and no response claims and acts to resolve claims/accounts, including drafting and submitting technical and clinical appeals. Provides support for all denial, no response, and audit activities. - Examines denied and other non-paid claims to determine the reason for discrepancies. - Communicates directly with payers to follow up on outstanding claims, files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement. - Ability to identify specific reasons for underpayments, denials, and cause of payment delay. Works with management to identify, trend, and address root causes of issues in the A/R. - Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly. - Documents all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system. - Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management. - Needs to be a strong problem solver and critical thinker to resolve accounts. Qualifications - Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel. - Excellent verbal skills. - Problem solving skills, the ability to look at accounts and determine a plan of action for collection. - Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment. - Adaptability to changing procedures and growing environment. - Meet quality and productivity standards within timelines set forth in policies. - Meet required attendance policies. - Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences. Requirements - 2 or 4-year college degree. - 1 or more years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing preferred. - Knowledge of claims review and analysis. - Working knowledge of revenue cycle. - Experience working the DDE Medicare system and using payer websites to investigate claim statuses. - Working knowledge of medical terminology and/or insurance claim terminology. Benefits - Bonus Incentives - Paid Certifications - Tuition Reimbursement - Comprehensive Benefits - Career Advancement
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Accounts Receivable Specialist
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Accounts Receivable Specialist I
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Accounts Receivable Specialist
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• Manage assigned insurance accounts receivable to ensure timely reimbursement and reduce aging balances. • Follow up with insurance payers on outstanding claims, underpayments, denials, and payment discrepancies. • Investigate and resolve claim denials by submitting corrected claims, appeals, reconsiderations, and supporting documentation in accordance with payer requirements. • Review claim edits and rejections to ensure accurate resubmission and minimize future denials. • Accurately post insurance payments, adjustments, and remittances into the billing system. • Perform daily payment reconciliation by ensuring posted payments align with electronic remittance advice (ERA), explanation of benefits (EOB), bank deposits, and payment reports. • Research and resolve unapplied cash, payment variances, overpayments, and underpayments. • Reconcile payer payments against contracted reimbursement rates and escalate payment discrepancies as appropriate. • Maintain accurate documentation of AR activities, payer communications, payment research, and resolution outcomes. • Respond professionally and empathetically to patient inquiries regarding insurance claims, billing statements, payment activity, balances, and Oshi's billing model, policies, procedures, and applicable healthcare regulations. • Maintain open communication with providers, payers, and internal stakeholders to investigate, resolve, and prevent claim and payment issues. • Collaborate with Billing, Eligibility & Benefits, Credentialing, Finance, Clinical Operations, and other cross-functional teams to resolve reimbursement issues and improve revenue cycle performance. • Analyze accounts receivable, payment, and denial data to identify trends, root causes, and opportunities for process improvement. • Monitor and report on AR performance, payment posting accuracy, denial trends, aging, and other key revenue cycle metrics, providing insights and recommendations to leadership. • Support month-end close activities, payment balancing, reporting, and audit requests. • Identify recurring reimbursement or operational issues and recommend process improvements to improve payment accuracy, accelerate cash collections, and reduce denials. • Ensure compliance with organizational policies, payer requirements, financial regulations, HIPAA, and healthcare billing standards while maintaining accuracy and integrity in all revenue cycle activities.



