Accounts Receivable Specialist - Healthcare Revenue Cycle

Job Summary: The Accounts Receivable Specialist plays a vital role in managing billing processes by directly engaging with commercial and governmental payers to resolve payment issues and ensure timely reimbursement. This position involves analyzing denials and payment discrepancies, implementing corrective actions, and maintaining clear communication to address payer errors effectively. Essential Responsibilities: Communicate directly with payers to follow up on outstanding claims, resolve payment variances, and secure prompt reimbursement. Investigate denied and underpaid claims to identify causes of discrepancies. Provide detailed explanations to payers regarding suspected underpayments and analyze denial reasons. Craft persuasive appeals to resolve denials using clear and effective language. Collaborate with management to identify trends and root causes of denials, contributing to strategies that reduce accounts receivable. Maintain up-to-date knowledge of federal and state regulations, payer requirements, and explanations of benefits to detect billing compliance issues. Keep accurate records of payer contacts, including names, addresses, phone numbers, and document all communications thoroughly. Handle communications from payers and internal departments with professionalism and efficiency. Utilize EPIC work queues, dashboards, and reports to prioritize follow-up on high-risk accounts. Participate in continuous quality improvement initiatives aimed at optimizing processes and systems. Demonstrate initiative by recommending improvements based on current trends. Adhere strictly to HIPAA guidelines when managing patient information. Perform additional duties as assigned. Education and Experience: High school diploma or equivalent required. Medical certification in Healthcare or Revenue Cycle preferred. One to three years of relevant experience required; three or more years preferred. Work Shift: First shift, full-time, 40 hours per week. This opportunity is located in a regional healthcare setting within the Midwest United States.

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