ASC Claims & Accounts Receivable Specialist

Company Description Horizon Solutions is an ASC Development and Management Company dedicated to helping ambulatory surgery centers operate and grow successfully. We partner with ASC leadership and center teams to provide expertise, infrastructure, and support across the business functions that keep a center running effectively. Our goal is to allow clinical teams and center leadership to focus on delivering exceptional patient care while Horizon provides the operational expertise and resources needed to support long-term success. Our Revenue Cycle team plays an important role in ensuring centers are financially healthy and positioned for continued growth.

Role Description We are seeking an experienced ASC revenue-cycle professional to join our team as an ASC Claims & Accounts Receivable Specialist. This role is responsible for managing assigned accounts from claim submission through payment, denial or appeal resolution, and final account closure.

The ideal candidate is someone who takes ownership of their accounts and does more than simply check claim status. You will be responsible for submitting clean facility claims, resolving rejections and denials, validating reimbursement, identifying and pursuing underpayments, and taking meaningful action to move each account toward an appropriate final resolution.

Position Location This is a remote position; however, candidates must be located in the Oklahoma City, Oklahoma area. The position requires regular collaboration and in-person meetings with the Revenue Cycle team, so proximity to the Oklahoma City area is an important requirement of the role.

Job Responsibilities

• Prepare, review, and submit accurate ASC facility claims; verify payer data, CPT/HCPCS and ICD-10-CM codes, modifiers, authorizations, provider information, and required attachments.
• Monitor clearinghouse reports, correct rejected claims promptly, and submit corrected, replacement, or reconsidered claims according to payer requirements and timely filing limits.
• Work unpaid, denied, delayed, and underpaid accounts for Medicare, Medicaid, Medicare Advantage, managed Medicaid, commercial, and other applicable payers.
• Review EOBs/ERAs and compare reimbursement with payer contracts, ASC fee schedules, case rates, carve-outs, and Medicare ASC payment methodology.
• Identify and pursue underpayments, incorrect bundling, improper reductions, and contract variances through payer inquiry, reconsideration, appeal, or escalation.
• Prepare and track denial appeals with supporting records, authorization evidence, payer policy, coding support, contract language, and proof of timely filing as appropriate.
• Bill and reconcile implants, devices, biologics, and high-cost supplies when applicable, including invoice or documentation requirements and separate-pay provisions.
• Maintain complete account notes and coordinate with coding, authorization, clinical, materials, contracting, and payment-posting teams to resolve root causes.

Experience

• 2 years of recent medical billing, insurance follow-up, or healthcare AR experience, including ASC or directly relevant outpatient facility billing experience.
• Hands-on experience with denials, appeals, clearinghouse rejections, unpaid claims, underpayments, payer portals, and timely filing and appeal deadlines.
• Working knowledge of ASC reimbursement, modifiers, CPT/HCPCS, ICD-10-CM, EOBs/ERAs, payer contracts, and facility claim requirements.
• Strong ownership, accuracy, organization, follow-through, communication, and independent problem-solving skills.
• Ability to work independently in a remote environment while maintaining consistent communication and accountability with the team.
• Must be located in the Oklahoma City, Oklahoma area due to regular in-person collaboration with the Revenue Cycle team.

Preferred:

• 3 years of ASC facility billing/AR experience.
• Experience with implant or device billing.
• Experience with contract or underpayment review.
• CPB, CPC, COC, CRCR, or comparable certification.