Accounts Receivable Specialist (REMOTE)

CommunityCare Revenue Cycle Management Role

Reporting to the Accounts Receivable Supervisor, this role supports the operations of the CommunityCare Revenue Cycle Management (RCM) team related to the follow up and resolution of outstanding insurance claims. Goal of the position is to follow up on, investigate and resolve claims that have been submitted to insurance for payment and to create detailed notes that provide insight into the current status of the individual claims.

Please note that we currently hire candidates exclusively from the following states : Arizona, Connecticut, Florida, Georgia, Michigan, North Carolina, Ohio, Texas.

Responsibilities

Essential Functions :

• Contact insurance carriers on a daily basis to follow up on / collect past due amounts on outstanding medical claims regarding denials or benefit changes.
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up.
• Keep educated on billing and medical policies for all payers.
• Have a working knowledge of In and Out of Network reimbursement processes / methodologies.
• Create and follow up on appeals needed to protest denials or incorrect payments.
• Review complex denials / tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary.
• Work across all RCM departments to get issues related to claims payment resolved.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Work with AR Supervisor to review / resolve open accounts as assigned.
• Perform other duties as assigned.

Knowledge, Skills and Abilities :

Qualifications

Minimum Education :

Minimum Experience :