About this role
Medical Accounts Receivable (A/R) Revenue Specialist
Position Summary
The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.
Key Responsibilities
Claims & Vendor Management
- Partner with external billing vendors to address claim rejections and payer requests for clarification.
- Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions.
- Review escalated accounts requiring internal oversight or final resolution.
Denial Management & Appeals
- Collaborate with vendor partners to identify denial trends, recurring payer issues, and root causes.
- Provide feedback and strategic direction on appeal approaches and payment resolution tactics.
- Authorize final adjustments after all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance.
- Recommend process improvements to reduce future denials.
Accounts Receivable Follow-Up
- Proactively work A/R aging reports (30, 60, 90+ days) to identify unpaid or underpaid claims.
- Initiate payer tracers and follow-ups to secure claim adjudication and payment.
- Monitor high-risk and high-dollar accounts to prevent revenue leakage.
Payment Posting & Reconciliations
- Ensure accurate posting and reconciliation of insurance and patient payments.
- Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy.
- Assist with account reconciliations and discrepancies resolution as needed.
Patient & Insurance Communication
- Act as a liaison between patients and insurance payers to resolve billing questions.
- Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.
- Conduct professional and empathetic phone communication with patients and payer representatives.
Qualifications & Requirements
Education
- High School Diploma or equivalent required
- Associates or Bachelors degree in Healthcare Administration, Accounting, or a related field preferred
Experience
- 1–3 years of experience in:
- Medical billing and collections
- Accounts Receivable or Revenue Cycle Management
- Healthcare payer follow-up and denial resolution
Technical Skills
- Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)
- Strong working knowledge of Microsoft Office, particularly:
- Excel (reports, aging analysis)
- SharePoint
Medical & Regulatory Knowledge
- Working knowledge of:
- Medical terminology
- CPT and ICD-10 coding
- Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans
Core Competencies
- Strong analytical and problem-solving skills
- Exceptional attention to detail and accuracy
- Effective written and verbal communication skills
- Ability to work collaboratively with internal teams and external vendor partners
- Sound judgment related to financial adjustments and account resolution