Billing Claims Specialist, Accounts Receivable

Job Description

Job Description

The Accounts Receivable (A/R) Specialist plays a critical role in integrating billing and revenue cycle best practices to ensure timely reimbursement for all payor groups, including contracted, non-contracted, and government payors. This position focuses on claims processing, managing accounts receivable, and addressing low pay claims, denials, payment discrepancies, and appeals. The successful candidate will be responsible for ensuring accurate billing, timely follow-up on outstanding accounts, and adherence to industry standards and payor requirements to optimize revenue cycle efficiency. This role requires a strong understanding of medical billing, coding practices, and healthcare regulations, along with a high attention to detail and excellent communication skills.

Essential Functions

• Answers and directs phone calls
• Responds to messages in a timely manner

• Investigates denied claims in a timely manner, researching the cause and submitting appeals as needed to ensure successful reimbursement
• Reviews and submits corrected claims for any errors, ensuring that all necessary information is updated to facilitate proper reimbursement
• Keeps assigned accounts and tasks current within the time frame set by the manager, ensuring efficient and organized management of workload
• Achieves or exceeds daily KPIs related to accounts receivable, claims follow-up, and collections

• Completes the processing of error claims and those with no activity in a timely manner to ensure no claims are left unresolved
• Corresponds with hospitals and doctor's offices to obtain missing information
• Forwards qualifying accounts to third party collections agency as needed
• Always adheres to HIPAA compliance, including when accessing client portals
• Supports positive change in the department
• Supports the team to improve collections, communicate issues, and implement ideas
• Supports internal and external audits by providing necessary documentation and addressing any audit findings
• All other duties as assigned

Job Requirements and Skills

• High school diploma
• 2+ year of medical billing experience (Pathology billing experience is a plus)
• Detail-oriented and ability to demonstrate a positive and proactive attitude
• Proper phone etiquette is a must
• Strong ability to detect billing errors, resolve discrepancies, and ensure data accuracy
• Excellent written and verbal communication skills
• Ability to multi-task in a fast-paced, high volume environment
• Proficient with RCM software (e.g., Epic, Cerner, or similar), EHR/EMR systems, Microsoft Office Suite (especially Excel), and payor websites
• Skilled in performing repetitive duties on a daily basis
• Ability to establish effective and professional working relationships with other staff members

Compensation and Benefits:

• The compensation range is $43,680 – $56,160 annually (non-exempt) paid semi-monthly on an eight (8) hour per day, forty (40) hour per week. Final salary offer subject to multiple factors including candidate experience and expertise, geographic location of the role, and current market data.
• 401(k) includes an employer match up to 4%
• Robust health plans including dental, vision, life, and mental health support.
• Offer generous annual vacation and sick time
• 10 paid holidays
• Annual scrub allowance for Lab roles

All offers of employment at Yosemite Pathology are contingent upon clear results of a thorough background check. Background checks will be conducted on all final candidates.