Accounts Receivable (US Healthcare)

Triple

Triple is leading the way in remote work solutions, helping small and medium-sized businesses in North America build highly efficient remote teams for Administration, Customer Service, Accounting, Operations, and back-office roles. Our focus has always been on our Clients, People, and Planet, ensuring our operations contribute positively across these key areas. Distinguished by its rigorous standards, Triple excels in:

• Selectively recruiting the top 1% of industry professionals
• Delivering in-depth training to ensure peak performance
• Offering superior account management for seamless operations

Embrace unparalleled professionalism and efficiency with Triple—where we redefine the essence of remote hiring.

Summary

The Accounts Receivable (AR) Specialist in US Healthcare is responsible for managing and resolving insurance and patient payment collections to ensure timely revenue realization. This role involves claim follow-up, denial management, appeal submissions, and maintaining accurate records in compliance with payer regulations and healthcare policies. The AR Specialist collaborates with billing, coding, and customer service teams to optimize cash flow and reduce aged AR.

Responsibilities

Claims Follow-Up:

• Proactively follow up with insurance companies (Medicare, Medicaid, Commercial) via phone, portal, or email for unpaid or underpaid claims.
• Analyze Explanation of Benefits (EOBs)/Electronic Remittance Advices (ERAs) for claim status.

Denial Management & Appeals:

• Review and identify reasons for claim denials and underpayments.
• Prepare and submit accurate appeals and corrected claims within payer deadlines.

Payment Posting Coordination:

• Work with the payment posting team to resolve misapplied payments, overpayments, and unposted remittances.
• Flag refunds or adjustments as needed.

Aging Report Analysis:

• Review aging reports and prioritize high-dollar or timely filing claims.
• Document all actions taken and maintain notes in billing software.

Compliance & Quality:

• Ensure all follow-up activities comply with HIPAA and payer-specific guidelines.
• Meet daily/weekly productivity and quality benchmarks (e.g., # of claims worked, resolution rate).

Communication & Coordination:

• Coordinate with clients, internal teams (billing, coding), and insurance representatives to resolve issues efficiently.
• Escalate complex issues to the team lead or AR manager as necessary.

Qualifications

Bachelor’s degree.

2–5 years of AR experience in US medical billing/RCM industry is a must

Knowledge of payer guidelines (Medicare, Medicaid, BCBS, UHC, etc.).

Hands-on experience with billing software (e.g., Kareo, AdvancedMD, Athenahealth, eClinicalWorks, NextGen, etc.).

Proficiency in MS Excel and claim tracking tools.

Strong understanding of the US healthcare revenue cycle and AR lifecycle.

Excellent analytical and problem-solving skills.

Effective verbal and written communication skills.

Ability to work independently and manage time effectively.

Knowledge of CPT, ICD-10, and HCPCS codes is an added advantage.

Schedule (US Shifts Only)

Eastern Time - 6:30 p.m. - 3:30 a.m. IST, Monday - Friday

Logistical Requirements

Quiet and brightly illuminated work environment

Laptop with Minimum 8GB RAM, I5 8th gen processor

720P Webcam and Headset

A reliable ISP with a minimum speed of 100 Mbps

Smartphone