Accounts Receivable Specialist

The responsibilities of an Accounts Receivable Specialist is to pursue reimbursement of services rendered and achieve accounts receivable resolution. specific tasks include resolving insurance carrier denials, appealing claims, contacting carriers on open accounts and responding to insurance carrier correspondence and/or inquiries.

• Consistently meet or exceed current productivity and quality standards in a timely resolution of all claim edits, reporting of candidates for bill, outbound complaint claim submission, clinical documentation requirements and any other communication required (verbal or written) regarding claims ensuring timely filing of claims and clean, complete and accurate claims
• Timely follow-up on denials and appeals, including root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
• Compliant follow‑up correspondence to third party payers regarding outstanding accounts receivables (i.e., Statements, letters, emails, faxes, portal mail, etc.).
• Understanding of payer types (i.e., Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers' Compensation, Corporate Accounts, Research, and Specialty AR Accounts).
• Understanding of payer Medical Reimbursement policies.
• Update registration information, post denial codes and adjustments in practice management systems.
• Recommend accounts for contractual or administrative write‑off and provide appropriate justification and documentation.
• Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
• Identify opportunities for customer, system and process improvements and submit to management.
• Follow the Riverside Healthcare general policies and procedures, the department policies and procedures and any emergency preparedness procedures.
• Assist with special projects and other duties as assigned, as necessary.

• At least 2 years of related work experience
• Detail oriented, good organizational skills, and ability to be self‑directed.
• Working knowledge of physician billing and follow up, including an understanding of insurance rules and regulations.
• Knowledge of HIPAA standards.
• Ability to perform mathematical calculations.
• Excellent communication skills when dealing with patients, families, public, co‑workers, and professional offices.
• Basic knowledge of medical terminology and billing practices.
• Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.

• Knowledge of Epic systems.
• Three or more years of progressive work experience in a hospital/physician billing or SBO

• High school graduate or equivalent

• Two years of college or college degree
• Physician coding certification (CPC through AAPC or CCA through AHIMA) preferred

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well‑being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable.

• Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift differential, on‑call
• Opportunity for annual increases based on performance

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short‑and‑Long‑Term Disability
• Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
• Defined contribution retirement plans with employer match and other…