Investigate and resolve unresolved claims (denials, underpayments, delayed payments); troubleshoot claim data and submit written appeals with supporting documentation and timely follow-up
Verify eligibility, identify payor changes, and accurately update coordination of benefits (COB); navigate payor portals to identify correct payors
Make outbound calls and collaborate with insurance payors and partner facility business offices for claim resolution; answer incoming calls professionally
Identify and communicate denial trends and coding issues to support clean claim processing
Perform account reconciliation — identify overpayments, complete refund requests, and process insurance takebacks via ERAs
Resolve assigned worklist items with detailed account documentation; maintain daily AR log reporting to Supervisor and meet department productivity standards

CPB preferred but not required; CPC (or CPC-A) preferred but not required
3+ years of medical billing and accounts receivable experience required
Advanced expertise in the revenue cycle management process and insurance claims processing cycle
Strong ability to read and understand EOBs; deep understanding of insurance denials and unresolved claims resolution; knowledge of ICD-10, CPT, HCPCS, and CMS-1500 claim format
Proficient in MS Office — Outlook, Excel (intermediate), and Word; skilled with computers and multiple web browsers
Critical thinker with strong problem-solving skills; high attention to detail; excellent organization and time management; ability to prioritize and manage time-sensitive situations with urgency
Strong verbal and written communication and customer service skills; effective communication with partner facilities, co-workers, patients, and insurance companies
Consistently dependable, honest, trustworthy, and professional; able to work independently; adaptable to changing procedures and a growing environment

Medical, Dental, Orthodontic, Vision, and Rx — 80% of employee monthly premiums covered; dependent coverage available at employee’s expense
Employer-sponsored Life, AD&D, and Disability Insurance
Voluntary supplemental plans: Accident, Cancer, Critical Illness, STD, Identity Protection, and more
Accrue up to 132 hours (16.5 days) of PTO in your first year, based on FTE status
8 paid holidays for full-time employees
401(k) with employer match on first 4%
Up to $2,000 annually for professional development (prorated based on FTE)
Monday–Friday schedule | Typical hours 7:30 AM – 4:00 PM PST (occasional overtime based on work volume)

Accounts Receivable Specialist

Key skills