We are seeking a detail-oriented and results-driven
Medical Accounts Receivable (A/R) Specialist to join our revenue cycle team. In this role, you will be responsible for managing assigned accounts and independently resolving outstanding insurance balances, denied claims, and underpayments to maximize reimbursement. The ideal candidate has strong knowledge of the medical billing lifecycle, payer guidelines, and appeals processes, with the ability to analyze complex claim issues and communicate effectively with insurance carriers and internal teams.
Key Responsibilities
- Manage assigned accounts receivable work queues and prioritize accounts to ensure timely follow-up.
- Investigate and resolve insurance claim denials, underpayments, and unpaid claims.
- Review and interpret Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and payer correspondence to determine appropriate next steps.
- Prepare and submit appeals to Medicare, commercial insurance carriers, workers compensation carriers, and auto insurance payers.
- Research claim status using payer portals, clearinghouses, and other available resources.
- Correct claim errors and resubmit claims with appropriate supporting documentation.
- Identify reimbursement trends, recurring denial patterns, and payer issues, escalating systemic concerns to leadership as needed.
- Collaborate with billing, coding, and management teams to resolve complex reimbursement challenges.
- Recommend appropriate resolution for accounts deemed uncollectible based on payer responses and collection efforts.
- Ensure compliance with HIPAA, payer regulations, and organizational policies.
- Meet established productivity, accuracy, and quality standards while maintaining thorough documentation of account activity.
Qualifications
- Minimum 3 years of experience in Medical Accounts Receivable, Insurance Follow-Up, or Revenue Cycle Management.
- Strong understanding of medical billing, insurance reimbursement, claim adjudication, and denial management.
- Experience working with Medicare, commercial insurance, workers compensation, and auto insurance payers.
- Proven experience preparing and submitting insurance appeals and resolving complex reimbursement issues.
- Ability to interpret EOBs, ERAs, payer policies, and claim status information accurately.
- Familiarity with electronic medical records (EMR), practice management systems, and payer portals.
- Excellent analytical, problem-solving, and organizational skills.
- Strong written and verbal communication skills with the ability to work independently.
- High level of accuracy, attention to detail, and ability to manage multiple priorities in a fast-paced environment.
- Experience with multiple medical specialties or multi-payer environments.
- Knowledge of ICD-10, CPT, and HCPCS coding concepts.
- Experience with major clearinghouses and healthcare billing software.
- Certification in medical billing, coding, or revenue cycle management is an advantage.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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Who are we
BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
