Medical Billing Specialist – AR Focused

Description

The Medial Billing Specialist is responsible for managing all aspects of the medical billing

and collections process for a multi-location urgent care organization. This role ensures the

timely and accurate submission of claims, effective management of accounts receivables, and

resolutions of billing issues including: denials, rejections, and modifier/coding issues to

maximize reimbursement and maintain compliance with payer regulations.

The Medical Billing Specialist, under the direction of the RCM manager will collaborate

closely with providers, front office staff, clinical teams, and management to identify and

resolve claim issues, improve charge capture, and ensure the efficient flow of revenue

throughout the billing cycle.

Typically, within 24 hours of patient discharge.

• Review, prepare, and submit electronic and paper claims accurately and timely.
• Verify Claim completeness, coding accuracy, and supporting documentation prior to claim submission.
• Monitor Claim acceptance, rejections, and edits through the clearinghouse and payer systems.
• Correct and resubmit rejected or denied claims promptly through our PM or clearinghouse system.

• Proactively manage and work assigned accounts receivable to ensure timely reimbursement and achievement of organizational A/R goals.
• Analyze aging reports and prioritize accounts based on payer, balance, aging category, and reimbursement impact.
• Follow up on outstanding claims through payer portals, telephone inquiries, and written correspondence to secure payment and resolve claim delays.
• Identify, investigate, and resolve underpayments, payment variances, denials, and non-payment issues in a timely manner.
• Monitor accounts approaching timely filing limits and take appropriate action to prevent avoidable write-offs.
• Maintain designated A/R work queues and productivity standards established by the organization.
• Escalate complex payer disputes, contract discrepancies, and unresolved reimbursement issues to management as appropriate.
• Identify trends contributing to increased A/R, denial rates, or delayed payments and recommend corrective actions.
• Collaborate with front office, back office, coding, and provider teams to address root causes of billing issues affecting reimbursement.
• Assist in developing workflows and process improvements designed to reduce days in A/R and increase collection efficiency.
• Pursue all appropriate reimbursement opportunities while ensuring compliance with payer contracts, regulations, and organizational policies.
• Monitor outstanding patient balances and coordinate with applicable departments to facilitate resolution when necessary.
• Maintain accurate documentation of all collection activities, payer communications, appeals, and account actions within the practice management system.
• Support month-end and year-end revenue cycle initiatives by focusing on aged receivables and high-priority collection opportunities.
• Consistently work to reduce aged accounts and maintain overall accounts receivable performance within established organizational benchmarks and goals.

• Analyze denial reasons and prepare appeals with supporting documentation.
• Track appeal outcomes and identify opportunities to reduce recurring denials.
• Escalate complex payer issues to billing leadership as appropriate.

• Partner with front office teams to resolve registration, eligibility, authorization, and demographic issues.
• Work with back office staff and providers to clarify documentation and coding concerns.
• Participate in process improvement initiatives to enhance revenue cycle performance.

• Assist with payment…