Revenue Cycle Specialist, A/R Follow Up

Revenue Cycle Specialist – A/R Follow-Up

ABOUT PGL

Physicians Group Laboratories (PGL) is a CAP-accredited diagnostic laboratory serving providers and patients across Louisiana. Our revenue cycle team makes sure the lab is paid correctly for the testing it performs, and that every claim is accurate, supported, and compliant before and after it leaves the building.

THE ROLE

You will manage an assigned portfolio of insurance accounts receivable from initial follow-up through final resolution. This role goes beyond documenting calls and follow-up activity. You will be responsible for identifying the root causes of delayed or unresolved claims, taking appropriate action to resolve issues and prevent recurrence, and ensuring timely recovery of revenue owed to the laboratory. All account activity and documentation must be accurate, thorough, and maintained to support internal and external audit requirements.

WHAT YOU WILL DO

A/R Follow-Up & Resolution

• Work an assigned inventory of unpaid, underpaid, and delayed insurance claims, prioritized by dollar value, aging, and timely-filing deadlines
• Follow up with commercial, Medicare, Louisiana Medicaid and Medicaid managed care, and other payers by phone, portal, and electronic correspondence
• Identify underpayments by comparing remittances (ERA/EOB) to contracted rates and fee schedules, and pursue recovery.

Denial Management & Appeals

• Research denials using CARC/RARC codes and determine the root cause: front-end (eligibility, demographics, prior authorization), coding and medical necessity, or payer error
• Prepare and submit corrected claims, reconsiderations, and appeals within payer deadlines, with complete supporting documentation
• Track appeal outcomes to learn which denial types are worth appealing and which should be prevented upstream.

Root Cause & Process Improvement

• Spot recurring denial and payer trends, quantify their dollar impact, and escalate to leadership with data
• Partner with client services, accessioning, and billing to fix upstream gaps (missing requisition data, diagnosis codes, insurance information) before they become denials.

Compliance & Documentation

• Document every action in the billing system clearly enough that anyone, including an auditor, can follow the account history
• Follow federal and state billing regulations, payer policies, and PGL compliance policies. Never add or change codes or diagnoses that are not supported by the ordering provider’s documentation
• Promptly identify and report credit balances and suspected overpayments so they can be refunded within required timelines
• Raise any billing practice that appears improper with the Compliance Officer or through PGL’s compliance reporting channel. Good-faith reports are protected from retaliation
• Protect patient health information in accordance with HIPAA.

WHAT SUCCESS LOOKS LIKE

• First 30 days: Trained on our billing system, payer portals, test menu, and payer mix, and working assigned accounts with support
• By 60 days: Independently managing a full inventory and meeting daily productivity targets
• By 90 days: Meeting aging and resolution benchmarks, and bringing forward at least one recurring denial issue with a recommended fix.

How performance is measured

• Accounts worked and resolved against daily targets
• Percentage of assigned A/R over 90 days, and its month-over-month trend
• Appeal overturn rate
• Timely-filing write-offs (goal: zero)
• Documentation quality on periodic audit review.

WHAT YOU BRING

Required

• 2 years of insurance A/R follow-up or denial management in a healthcare setting
• Working knowledge of EOBs/ERAs, CARC/RARC denial codes, and CPT and ICD-10 fundamentals
• Experience with payer portals (e.g., Availity) and a practice management or billing system
• Comfort with Excel for sorting, filtering, and tracking work
• Clear, professional phone and written communication, and persistence with payers
• High school diploma or equivalent

Preferred

• Clinical laboratory billing experience (pathology and laboratory CPT codes, including molecular and toxicology testing)
• Familiarity with Medicare medical necessity rules (NCDs/LCDs), ABNs, and MolDX
• Experience with Louisiana Medicaid and Medicaid managed care plans
• Revenue cycle certification such as CRCR or CPB.

WHY JOIN PGL

• Your impact is visible. In an organization our size, you can see the direct impact your work has on revenue, operations, and the overall success of the business.
• Your perspective matters. We value people who think beyond the task at hand, use data to identify opportunities, and bring forward ideas that improve how we work.
• Integrity guides our decisions. Accuracy and compliance come before speed. We encourage our team members to ask questions, raise concerns, and do what is right for our patients, clients, and organization.
• Benefits: Medical, dental, vision, PTO, paid holidays, 401(k) with match.

SCHEDULE & LOCATION

• On-site at the Physicians Group Laboratory, Houma Location.. This is not a remote or hybrid position.

• Monday–Friday, 8:00 a.m.–4:30 p.m.

PHYSICAL REQUIREMENTS & WORK ENVIRONMENT

Office environment. Requires prolonged sitting and extended computer and phone use. Occasionally lifts up to 15 lbs. Reasonable accommodations are available to enable individuals with disabilities to perform the essential functions of the role.

PGL is an equal opportunity employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other characteristic protected by law.