Accounts Receivable Associate (Hybrid)

Position Summary 

The Account Receivable Associate is responsible for reviewing outstanding denied claims with Medicare, Medicaid and Commercial insurance companies. This role involves following up with insurance companies to check claim status, reviewing medical records request and submitting required documentation to payors.  

Job Responsibilities 

• Review insurance denials and take appropriate action. 

• Check claims status via phone or portal. 

• Submit Medical Records upon request and follow up on submission. 

• Submit HCFA’s claims to insurance companies that do not accept electronic claims. 

• Submit Retros authorization 

• Work closely with insurance companies to resolve claims disputes. 

• Identifying and resolving billing errors and implementing processes to prevent future issues. 

• Identifying and communicating process errors to optimize revenue cycle management.  

• Utilize payor portals to gather claims status information. 

• Respond promptly and professionally to inquiries from insurance companies, patient, and client’s representative with good customer service. 

• Ensure billing practices comply with HIPAA, CMS guidelines and payor specific policies 

• Communicate with insurance companies daily. 

• Must meet or exceed production and quality standards. 

Required Qualifications 

• High School diploma or equivalent required. 

• 1-2 years of experience in a related industry 

• Strong understanding of Explanation of Benefits (EOBs) to determine denial reasons and appropriate actions. 

• Strong communication and interpersonal skills . 

• Ability to work independently and as part of a team. 

• Attention to detail and strong organizational skills. 

• Basic experience using computer software, including medical billing software. 

• Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use. 

• Strong Problem-Solving skills with attention to detail. 

• Moderate knowledge of CPT, ICD-10 

• Ability to adapt to frequent changes and manage tasks efficiently 

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Preferred Qualifications 

• Associate’s degree accounting, finance, healthcare administration, or a related field OR equivalent combination of education and experience  

• Must possess professionalism, superior organizational skills, communications skills that allow the ability to educate and influence, an unrelenting passion for persistent follow up, and a drive towards problem resolution.  

• Drive for Results (Service, Quality, and Continuous Improvement) – Ensure procedures and processes are in place that will lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement. 

• Communication – Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization to achieve the desired results. 

• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team. 

• Customer Service Focus – Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations. 

Physical Demands 

• Must possess ability to sit and/or stand for long periods of time. 

• Must possess ability to perform repetitive motion. 

• Ability to lift up to 15 pounds. 

• The majority of work is performed in a desk/cubicle environment. 

Training 

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.  

Other  

• Willingness to work shift work and overtime. 

• Job may require occasional weekends, evenings, and/or holidays.