Accounts Receivable Specialist Job Covington area,Kentucky USA,Healthcare

Function

The Accounts Receivable Representative is responsible for reviewing, researching, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This role requires strong knowledge of healthcare billing, payer guidelines, denial management processes, and revenue cycle operations. The representative works closely with insurance companies, providers, and internal departments to ensure accurate claim resolution and timely payment.

Essential Duties and Responsibilities

Review and analyze denied, rejected, and underpaid insurance claims.

Investigate denial reasons and identify appropriate corrective actions.

Prepare and submit first-level and second-level appeals to commercial, government, and managed care payers.

Monitor appeal status and follow up with insurance carriers to ensure timely resolution.

Research payer policies, contracts, and reimbursement guidelines to support dispute resolution.

Document all account activity, correspondence, and appeal actions accurately within billing systems.

Identify trends in denials and recommend process improvements to reduce future claim rejections.

Resolve claim discrepancies related to coding, eligibility, authorizations, medical necessity, and billing errors.

Maintain productivity and quality standards while managing assigned accounts receivable inventories.

Collaborate with coding, billing, patient access, and clinical departments to obtain supporting documentation.

Ensure compliance with HIPAA regulations, payer requirements, and organizational policies.

Meet departmental goals for collections, denial resolution, and aging account reduction.

Perform other duties as assigned or needed.

Working Conditions / Environment

Shift is generally day shift, Monday – Friday.
Holidays, weekends, and extra hours may occasionally be required.
Meals are provided for staff when on campus.
Office setting with extensive computer usage; prolonged periods of computer work, telephone communication, and detailed account review.

Minimum

Job Requirements

Education: High School Diploma or GED required. Associate Degree in Business or Medical Billing and Coding field preferred; work experience or other education may be considered in lieu of a degree.
Experience: Minimum 2 years of experience in healthcare (BH, CCBHC, RHC/FQHC, physician practice, or third‑party billing), accounts receivable, denial management, medical billing, or revenue cycle operations. Experience with insurance appeals, claim follow‑up, and denial resolution.
Skills & Knowledge:
- Must be at least 21 years of age.
- Knowledge of Medicare, Medicaid, commercial insurance, and managed care payer regulations.
- Knowledge of payer contract interpretation and reimbursement methodologies.
- Familiarity with CPT, ICD‑10, and HCPCS coding principles.
- Proficiency in electronic medical records (EMR) and healthcare billing systems.
- Strong analytical, problem‑solving, and organizational skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities and meet deadlines in a fast‑paced environment.
- Proficiency with Microsoft Word, Excel, PowerPoint, and other organizational applications.
- Ability to interface well with all departments in a highly professional manner and understand and relate to clients from diverse backgrounds.
- Read, write, and converse in English.
- Successful completion of a pre‑employment drug screen, background screening, and TB skin test or proof of a negative chest x‑ray.
Licenses &

Certifications:
- Successful completion of Excellent Foundations.
- Maintain 20 hours of annual training.
- Certification in medical billing, coding, or revenue cycle management is preferred.
Physical Requirements: Regularly required to stand, sit, walk, talk, hear, reach with hands and arms, use a computer keyboard and mouse. Occasionally required to stoop, kneel, crouch, climb stairs, lift or move up to 10 pounds. Vision requirements include close, distance, and peripheral vision.
Supervisory Requirements: N/A

Benefits & Compensation

This position is eligible for our full‑time employee benefit package, including a 401(k) program with immediate vesting and dollar‑for‑dollar matching up to 6%, paid leave, health/dental/vision, and other competitive benefits.

Rate of pay: $17.00–$21.00 per hour.

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