We are seeking an experienced
Bilingual Accounts Receivable Specialist to join our orthopedic medical billing team. This role is responsible for actively managing insurance accounts receivable, resolving unpaid and underpaid claims, working denials and appeals, and ensuring timely and accurate reimbursement for services provided.
The ideal candidate is
fluent in both English and Spanish and has hands-on experience in
medical billing, insurance A/R, claims follow-up, denials management, and appeals. The successful candidate will have a strong understanding of
Medicare, Medicare Advantage, PPO, POS, HMO, and commercial insurance plans, as well as working knowledge of CPT and ICD-10-CM coding.
Key Responsibilities
- Manage and follow up on outstanding insurance accounts receivable.
- Review A/R aging reports and prioritize accounts based on age, balance, payer, and urgency.
- Investigate unpaid, underpaid, rejected, and denied claims to determine the root cause.
- Contact insurance companies by phone and use payer portals to verify claim status and obtain payment information.
- Review EOBs and ERAs to identify payments, adjustments, denial reasons, and reimbursement discrepancies.
- Correct claim and billing errors and submit corrected claims when appropriate.
- Research and resolve claim issues involving eligibility, benefits, referrals, authorizations, coding, modifiers, and payer requirements.
- Prepare and submit claim reconsiderations, disputes, and appeals with appropriate supporting documentation.
- Monitor and follow up on corrected claims and appeals until resolution.
- Identify and investigate underpayments and payer reimbursement discrepancies.
- Review CPT codes, ICD-10-CM codes, modifiers, and other claim information for accuracy.
- Identify recurring denial patterns and communicate trends to the appropriate billing or management team.
- Verify insurance eligibility, benefits, referrals, and authorization information as needed to resolve outstanding claims.
- Communicate professionally with insurance carriers, patients, referring providers, and other healthcare organizations.
- Accurately document all A/R activity, payer communications, and claim follow-up in eClinicalWorks (eCW).
- Maintain organized and timely follow-up on assigned accounts.
- Assist with patient account inquiries and outstanding patient balances when necessary.
- Maintain strict patient confidentiality and comply with HIPAA and applicable healthcare regulations.
- Collaborate with billing, front office, clinical, provider, and administrative teams to identify and resolve revenue cycle issues.
- Meet established productivity, quality, accuracy, and A/R follow-up expectations.
Qualifications
- Bilingual in English and Spanish required.
- Previous medical billing or healthcare accounts receivable experience required.
- Hands-on experience with insurance A/R, claim denials, appeals, and payment discrepancies strongly preferred.
- Strong understanding of Medicare, Medicare Advantage, PPO, POS, HMO, and commercial insurance plans.
- Working knowledge of CPT, ICD-10-CM, modifiers, and medical terminology.
- Strong understanding of EOBs, ERAs, denial codes, claim adjustments, and payer correspondence.
- Experience navigating insurance payer portals and websites.
- eClinicalWorks (eCW) experience preferred.
- Orthopedic, surgical, or specialty medical billing experience is a strong advantage.
- Strong computer, data-entry, and documentation skills.
- Excellent verbal and written communication skills in English and Spanish.
- Strong analytical, organizational, investigative, and problem-solving abilities.
- Exceptional attention to detail and accuracy.
- Ability to independently research an unpaid claim, determine the appropriate action, and follow it through resolution.
- Ability to prioritize high-dollar, high-risk, and aging accounts in a fast-paced environment.
- Self-motivated, dependable, accountable, and comfortable working with minimal supervision.
- Ability to consistently meet A/R follow-up, productivity, and quality expectations.
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
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