Accounts Receivable (AR) Specialist

Position Summary:

4 years of hands-on experience

Essential Functions:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Responsible for all aspects of AR follow-up and collections, including making phone calls, sending correspondence, and accessing payer websites.

• Identify trends and perform root cause analysis on unpaid and underpaid claims.
• Research, appeal, and resolve claim rejections, denials, and underpayments with appropriate insurance payers.
• Initiate phone or written communication with patients to obtain missing or additional information as required.
• Accurately document all collection and follow-up activity in the system.
• Develop and maintain positive working relationships with clinical staff, internal teams, and payer representatives.
• Maintain professionalism and adhere to company policies in appearance, communication, and conduct.
• Meet deadlines, manage priorities, and keep the supervisor informed about progress and issues.
• Ensure compliance with HIPAA, OSHA, and all applicable State and Federal regulations.
• Perform other related duties as assigned by management.

Qualifications:

Required:

• Minimum

  4 years of experience

  in Accounts Receivable / Medical Billing and Collections.
• Strong operational knowledge of healthcare RCM processes, payer portals, and insurance claim workflows.

Preferred:

• Any Graduate
• Proficiency in MS Office Suite (Excel, Word, Outlook).

Certifications (Preferred):

• AHIMA or AAPC Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).

Knowledge, Skills & Abilities:

• Strong understanding of HMO/PPO, Medicare, Medicaid, and other payer guidelines.
• Working knowledge of

  HCPCS, CPT, and ICD-10

  coding.
• Excellent analytical and problem-solving skills with the ability to perform root cause analysis.
• Strong communication and negotiation skills when interacting with payers and patients.
• Highly organized, detail-oriented, and results-driven.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Demonstrates integrity, accountability, and professional behavior in all interactions.
• Customer serviceoriented, empathetic, and adaptable.