Job Description – Accounts Receivable Specialist (Medical & Insurance Billing)

Position Title: Accounts Receivable (A/R) Specialist
Department: Finance / Billing
Reports To: Controller or Billing Manager
FLSA Status: Non-Exempt (Hourly)

Position Summary

The Accounts Receivable (A/R) Specialist is responsible for managing the full cycle of medical billing and insurance claims, including timely submission, follow-up, payment posting, and resolution of denials. This role ensures that all outstanding patient and insurance balances are accurately tracked, collected, and reconciled to optimize cash flow and maintain compliance with regulatory and payer requirements.

Key Responsibilities

Billing & Claims Management

• Prepare, review, and submit accurate medical claims to insurance payers (primary and secondary) in compliance with payer requirements and deadlines.

• Verify patient coverage, eligibility, and authorizations prior to billing.

• Correct and resubmit any rejected or denied claims.

Accounts Receivable & Collections

• Monitor A/R aging reports and follow up on unpaid claims, denials, and underpayments.

• Post insurance and patient payments accurately to the appropriate accounts.

• Contact insurance companies and patients as needed to resolve outstanding balances.

• Maintain documentation of all follow-up actions taken on accounts.

Insurance & Patient Communication

• Serve as the primary contact for insurance carriers regarding claim status, discrepancies, and payment inquiries.

• Educate patients on their account balances and assist with payment arrangements as needed.

Reconciliation & Reporting

• Reconcile payments, adjustments, and write-offs to ensure accurate A/R records.

• Provide weekly and monthly reports on collections, aging, and outstanding balances to management.

• Identify trends in denials or underpayments and collaborate with management to improve processes.

Compliance & Best Practices

• Maintain compliance with HIPAA and all federal/state billing regulations.

• Stay updated on payer policies, coding updates, and industry best practices.

• Support internal and external audits by providing documentation and account histories.

Key Performance Indicators (KPIs)

• Days in A/R within industry benchmarks (typically < 45 days).

• Percentage of claims paid on first submission.

• Reduction of aged A/R over 90 days.

• Timely follow-up on denials and rejections.

Qualifications

• Education: High school diploma or GED required; Associate’s degree or medical billing certification preferred.

• Experience:

  • 2 years of experience in medical billing and A/R, preferably in a healthcare or behavioral health setting.

  • Experience with insurance verification, claim submission, and follow-up.

  • Familiarity with CPT, HCPCS, ICD-10 coding, and payer regulations a plus.

• Skills:

  • Strong attention to detail and organizational skills.

  • Excellent verbal and written communication skills.

  • Proficiency with billing software, EHR systems, and Microsoft Excel.

  • Ability to prioritize and manage multiple tasks in a deadline-driven environment.