Accountabilities

• Accounts receivable follow-up: Manage outstanding government and commercial healthcare insurance receivables, researching unpaid, denied, and underpaid claims to secure timely reimbursement.
• Eligibility and authorization: Verify or obtain patient eligibility, service authorizations, and applicable control numbers through payer websites, client systems, and direct communication with insurance carriers or providers.
• Claims research and resolution: Investigate missing information, billing errors, payment discrepancies, low reimbursement, denials, and other issues, taking appropriate action to resolve or resubmit claims.
• Payment and EOB analysis: Review Explanation of Benefits (EOBs), claims data, and applicable billing documentation to identify payments, adjustments, underpayments, and opportunities for recovery.
• Payer communication: Contact insurance carriers by phone or written correspondence to obtain claim payments, clarify requirements, pursue reconsiderations, and resolve outstanding issues.
• Appeals and documentation: Prepare technical appeal letters, obtain required medical documentation, research provider billing manuals, and support claims requiring clinical audit review.
• Contract and reimbursement review: Research contracts and claims information to validate underpayments and determine whether reimbursement aligns with applicable contractual requirements.
• Data and documentation management: Update patient demographics and insurance information, maintain accurate account notes, and follow prioritization, timely filing, and documentation protocols.
• Compliance: Handle patient information in accordance with HIPAA and applicable regulatory requirements, follow established compliance policies, and promptly escalate potential compliance concerns.
• Performance: Meet established productivity and performance expectations, including a target of approximately 55 claims per day or 275 claims per week.

Requirements

• Education: High school diploma or GED required.
• Healthcare AR experience: At least three years of experience in healthcare insurance accounts receivable, preferably within a hospital or hospital system and involving direct interaction with government or commercial payers.
• Claims expertise: Demonstrated experience identifying billing errors, resubmitting claims, following up on payment discrepancies and denials, and addressing low reimbursement.
• Healthcare documentation: Experience reviewing EOBs and CMS-1500 forms as part of accounts receivable activities.
• Revenue cycle knowledge: Strong understanding of medical business office procedures, accounts receivable practices, coordination of benefits, denial overturns, and third-party payer billing and reimbursement processes.
• Systems experience: At least three years of experience using accounts receivable software, with experience navigating payer portals for benefits verification, appeals, reconsiderations, and online claims follow-up.
• Payer knowledge: Experience working with Medicare and Medicaid is required; familiarity with other government and commercial insurance processes is highly valuable.
• Technical skills: Proficiency with Microsoft Office, including Excel for data entry, sorting, and organization, as well as email, calendar, and web-based systems.
• Communication: Ability to communicate effectively with payers, interpret complex information, document interactions accurately, and maintain professional relationships.
• Collaboration and performance: Ability to work effectively with cross-functional teams, meet established performance objectives, and manage a high-volume workload with accuracy.
• Preferred experience: Experience with Epic is preferred, as is experience managing both hospital/facility and physician/professional-fee accounts receivable.

Benefits

• Compensation: $20.00–$23.00 per hour, with actual compensation varying based on factors such as geographic location, experience, certifications, and skills.
• Work arrangement: Fully remote position within the United States.
• Healthcare environment: Opportunity to contribute directly to healthcare revenue cycle operations and financial performance.
• Professional development: Exposure to diverse payer processes, claims resolution, reimbursement practices, and healthcare compliance requirements.
• Collaborative culture: Work with cross-functional teams and healthcare stakeholders toward shared operational and financial goals.
• Equal opportunity: The role is offered in an environment committed to fair employment practices and equal opportunity.