Accounts Receivable Specialist (REMOTE)

CommUnityCare Health Centers - Austin, TX

Full-time

Remote - Austin, TX

About the position

This position supports the CommunityCare Revenue Cycle Management (RCM) team by following up on and resolving outstanding insurance claims. The role involves daily communication with insurance carriers to collect past due amounts, maintaining accurate account aging, and ensuring compliance with billing policies. The goal is to investigate and resolve claims efficiently while providing excellent customer service and adhering to the organization's mission and values.

Responsibilities

• Contact insurance carriers daily to follow up on and 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.
• Stay 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 appeals as necessary.
• Work across all RCM departments to resolve issues related to claims payment.
• Uphold and ensure compliance with 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.

Requirements

• High School Diploma or GED.
• 3 years of experience managing Accounts Receivable and performing direct follow-up with payers.
• 1 year experience communicating effectively, both orally and in writing, with insurance payers and internal company communications.
• 3 years working with medical terminology, ICD10, CPT, HCPCs coding, and HIPAA requirements.
• 2 years of experience with data processing and analytical skills, proficiency in Excel and Microsoft Office Suite, as well as medical practice management software and electronic medical records.
• 3 years of experience working with commercial, government, and state insurance payers and their reimbursement policies and procedures.
• 3 years' experience working complex insurance issues, including assigning correct payer, EOB adjustments, and refunds to accounts.