Specialist , Insurance Receivable

• Manage insurance receivables for inpatient and outpatient accounts across hospital and professional billing
• Review, analyze, and work assigned claims through final resolution to support accurate and timely reimbursement
• Submit claims and conduct timely follow-up with commercial, government, and other third-party insurance carriers
• Interpret electronic and paper remittance advice to identify denials, underpayments, nonpayments, and reimbursement discrepancies
• Investigate and resolve claim edits, payer rejections, documentation requests, payment delays, and outstanding balances
• Prepare corrected claims, appeals, payment transfers, insurance refunds, recoding, and contractual adjustments as appropriate
• Contact insurance carriers through payer websites, telephone, email, and written correspondence to obtain claim status and resolve account issues
• Update insurance information, verify eligibility, resubmit claims, and document all account activity accurately in Epic
• Identify payer trends, elevate recurring reimbursement issues, and collaborate with internal teams to support compliant billing practices
• Work 9:00 AM-5:00 PM, with schedule flexibility after training and independent performance
• Report to the Supervisor, Revenue Cycle

• Relevant experience in healthcare revenue cycle, insurance follow-up, claims management, reimbursement, or a comparable office setting preferred
• Knowledge of both hospital and professional billing processes
• Experience working with commercial, government, and third-party insurance carriers
• Knowledge of Epic, including claim review, account documentation, work queues, insurance updates, and follow-up activities
• Ability to work claims from initial submission through final resolution and accurately interpret remittance advice
• Strong analytical and problem-solving skills for resolving denials, payment discrepancies, underpayments, and payer-related issues
• Ability to manage high-volume work queues, prioritize aging accounts, and meet productivity and follow-up expectations
• Clear written and verbal communication skills for working with insurance carriers, internal departments, and leadership
• Adaptability and comfort working in a changing environment with evolving systems, payer requirements, workflows, and departmental priorities

Demonstrates expertise in managing insurance receivables and claims resolution within the healthcare revenue cycle, utilizing strong analytical skills to address payment discrepancies and ensure accurate reimbursement. Proficient in using Epic for documentation and follow-up activities while maintaining effective communication with insurance carriers and internal teams.

• Healthcare Revenue Cycle Management
• Claims Management
• Epic Proficiency
• Analytical Problem-Solving
• Insurance Follow-Up

• Claims Submission
• Reimbursement Analysis
• Denial Resolution
• Payment Discrepancy Investigation
• Contractual Adjustments
• Eligibility Verification
• Account Documentation
• Payer Trend Identification
• High-Volume Work Queue Management
• Remittance Advice Interpretation

• Clear Communication
• Adaptability
• Problem-Solving
• Collaboration
• Time Management

• Inpatient Billing
• Outpatient Billing
• Commercial Insurance
• Government Insurance
• Third-Party Insurance
• Reimbursement Discrepancies
• Payment Delays
• Insurance Carriers
• Healthcare Compliance
• Billing Practices

• Epic
• Payer Websites
• Email Communication
• Telephone Correspondence
• Written Correspondence