Revenue Cycle Specialist - A/R Follow-Up (Houma, LA)

Revenue Cycle Specialist – A/R Follow-Up

Physicians Group Laboratories | Houma, LA | On-Site | Full-Time | Non-Exempt (Hourly)

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 amp; 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 amp; 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 amp; 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 amp; 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