Revenue Cycle A/R Representative (Hybrid)

About the Role

We are seeking a detail-oriented Revenue Cycle & Accounts Receivable Specialist to join our team in a hybrid capacity. In this role, you will manage the lifecycle of patient and insurance receivables from billing through final resolution. You will be responsible for reconciling payments, preparing electronic and paper claims, managing appeals, and processing refunds to optimize our financial health and support patient satisfaction.

KEY RESPONSIBILITIES 

• Account Resolution: Own assigned accounts holistically, following up diligently with payers and patients to secure accurate, timely payments.
• Claims & Billing: Prepare, review, and submit claims and financial statements electronically or via paper to various insurance carriers and patients.
• Denial Management: Analyze claim denials to identify root causes, file precise appeals, resubmit corrected claims, and track trends to mitigate future revenue leakage.
• Payment Reconciliation: Review and interpret insurance benefits, EOBs, ERAs, and payer policies to verify correct reimbursement and identify underpayments.
• Credit & Refund Analysis: Conduct detailed account audits to identify balances requiring bad debt placement, investigate potential insurance overpayments, and route refund documentation for approval.
• Compliance Documentation: Log all account activity clearly and accurately within the Electronic Medical Record (EMR) system to maintain audit readiness.
• Cross-Functional Collaboration: Partner with billing, patient access, and payment posting teams to resolve systemic issues and notify management of emerging payer trends.

Organizational Expectations

As a valued team member at Ashley, Inc., you will also:

• Model and reinforce our core mission, vision, and organizational values.
• Protect patient privacy by strictly maintaining compliance with HIPAA guidelines and IT security regulations.
• Support our ongoing commitment to diversity, equity, and inclusion in the workplace.
• Perform other operational duties on an as-needed basis to support team success.

DESIRED KNOWLEDGE/SKILLS/ABILITIES:

• High school diploma or GED required.
• Minimum 2 years of experience in insurance/patient billing and healthcare claims processing and follow-up required.
• Strong knowledge of third-party payer guidelines, procedures, and denial processes.
• Ability to calculate figures accurately and reconcile accounts with attention to detail.
• Proficient in basic Microsoft Office applications, including Outlook, Word, and Excel.
• Demonstrated ability to make timely decisions using sound judgment and to clearly explain the rationale for actions taken.