Insurance Accounts Receivable Specialist

Position Summary

The Insurance Accounts Receivable Specialist is a member of the Finance Team and plays an important role in maintaining the financial health of the practice. This position is responsible for actively managing insurance accounts receivable, following up on unpaid and denied claims, resolving insurance payment issues, and ensuring outstanding insurance balances are addressed in a timely and consistent manner.

The Insurance Accounts Receivable Specialist works closely with other members of the Finance Team, front office staff, clinical staff, and insurance carriers to resolve claim issues and ensure appropriate reimbursement. This position is responsible for maintaining accurate documentation, following established insurance A/R workflows, identifying problem accounts, and escalating or handing off issues when appropriate.

The position is focused specifically on insurance accounts receivable and does not have primary responsibility for patient collections or patient account balances.

Education and Experience

• High school diploma or equivalent required.
• Minimum of two (2) years of medical office, medical billing, insurance follow-up, or accounts receivable experience preferred.
• Nextech experience highly valued.
• Ophthalmology or healthcare revenue cycle experience strongly preferred.
• Certifications related to this specific is highly desirable
• Experience working with insurance carriers and medical practice management systems preferred.

Essential Skills and Abilities

• Excellent written and verbal communication skills.
• Must be proficient in excel and pivot tables along with basic command functions.
• Strong organizational skills and attention to detail.
• Excellent follow-up and problem-solving skills.
• Ability to manage multiple priorities and deadlines.
• Ability to work independently while functioning effectively as a member of the Finance Team.
• Professional and effective communication with insurance carriers and internal team members.
• Ability to analyze account information and determine appropriate next steps.
• Ability to maintain accurate and thorough documentation.
• Ability to follow established workflows and appropriately escalate or hand off issues.

Purpose of Role

To proactively manage insurance accounts receivable, reduce outstanding insurance balances, resolve unpaid and denied claims, and ensure insurance accounts are worked consistently and timely according to established Finance Team workflows.

Responsibilities

1. Insurance Accounts Receivable

• Actively work assigned insurance accounts receivable according to established Finance Team workflows and priorities.
• Review outstanding insurance claims and determine the appropriate follow-up action.
• Contact insurance carriers regarding unpaid, denied, pending, or incorrectly processed claims.
• Research claim status, payment information, denial reasons, and payer requirements.
• Determine the appropriate next step for unresolved claims, including corrected claims, reconsiderations, appeals, or additional documentation.
• Submit corrected claims and supporting documentation when appropriate.
• Follow up on submitted claims, appeals, and reconsiderations until a final resolution is received.
• Maintain accurate and timely documentation of all insurance follow-up activity in the practice management system.
• Ensure assigned claims are worked within established timeframes.
• Identify claims that require escalation to coding, front office, clinical staff, or another Finance Team member.

2. A/R Aging Management

• Review insurance A/R aging reports regularly and prioritize accounts according to established Finance Team guidelines.
• Work aging insurance accounts consistently, with particular attention to balances that are 60, 90, and 120 days outstanding.
• Prioritize high-dollar insurance accounts and accounts with significant financial impact to the practice.
• Maintain assigned A/R worklists and ensure accounts are actively worked.
• Research and resolve barriers preventing timely insurance payment.
• Identify trends within aging A/R and communicate concerns to the Finance Manager or designated supervisor.
• Participate in regular A/R review meetings and provide updates on assigned accounts.
• Assist with department initiatives designed to reduce aged insurance A/R and improve reimbursement.

3. Insurance Denials & Appeals

• Review insurance denials to determine the reason for denial and appropriate resolution.
• Research payer policies, claim history, authorization information, coding, and documentation when necessary to resolve denied claims.
• Coordinate with coding, eligibility, prior authorization, front office, Surgery department and clinical team members when additional information or correction is required.
• Submit appeals, reconsiderations, corrected claims, or other payer-required documentation when appropriate.
• Track appeals and reconsiderations through final resolution.
• Identify recurring trends and communicate them to the appropriate Finance Team member.
• Assist with identifying opportunities for process improvement and denial prevention.
• Escalate complex, high-dollar, or unresolved denials according to established workflows.

4. Insurance Carrier Communication

• Contact insurance carriers by phone, portal, electronic communication, or other approved methods to resolve outstanding claims.
• Obtain claim status, payment information, explanation of benefits information, denial reasons, and payer requirements.
• Provide insurance carriers with appropriate documentation and information needed to process claims.
• Maintain professional and effective communication with insurance representatives.
• Document all relevant insurance communications and follow-up activity.

5. Finance Team Collaboration

• Work as an active member of the Finance Team to support the overall financial health of the practice.
• Work with other members of the Finance Team to resolve insurance-related issues.
• Collaborate with coding, eligibility, prior authorization, patient assistance, front office, and clinical team members when claim resolution requires additional information or action.
• Escalate or hand off issues in accordance with established workflows.
• Communicate recurring insurance issues, payer trends, and barriers to reimbursement to the appropriate Finance Team member or Finance Manager.
• Assist other Finance Team members when needed to support department priorities.
• Participate in Finance Team meetings and process improvement initiatives.

6. General Insurance A/R Duties

• Maintain accurate and timely documentation of all assigned insurance A/R activity.
• Periodic reporting, and data analysis is apart of general duties of reporting
• Work within the practice management system to resolve assigned insurance account issues.
• Monitor assigned claim worklists and follow-up queues.
• Review and resolve assigned unbilled or exclusion items when applicable to insurance billing.
• Maintain daily or weekly follow-up logs as required.
• Assist with monthly insurance A/R reporting and reconciliation as assigned.
• Identify accounts requiring additional research, correction, escalation, or handoff.
• Complete other insurance A/R duties as assigned by the Finance Manager or designated supervisor.

Performance Expectations

The Insurance Accounts Receivable Specialist is expected to:

• Consistently work assigned insurance A/R within established timeframes.
• Demonstrate measurable progress in reducing aged insurance A/R.
• Maintain accurate and complete documentation of insurance follow-up.
• Follow established Finance Team workflows and escalation procedures.
• Demonstrate timely and professional communication with insurance carriers and internal team members.
• Assist with internal and external communication requests in a timely and professional manner, including requests involving insurance carriers, patients, clinical staff, front office staff, leadership, and other external parties, as appropriate to the role.
• Identify and communicate recurring payer and claim issues.
• Maintain confidentiality and professionalism when handling patient and insurance information.
• Work collaboratively with the Finance Team to support timely and accurate insurance reimbursement.

Continuing Education

Southwest Eye Consultants supports continued professional development and advanced education. Employees are encouraged to pursue additional education and certifications related to medical billing, revenue cycle management, insurance reimbursement, accounts receivable, and/or ophthalmology billing.

This position requires a working knowledge of Front Office operations, insurance processes, medical billing, claim follow-up, and the practice's established revenue cycle workflows.

Pay: $20.00 - $22.00 per hour

Expected hours: 45.0 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan
• Vision insurance

Work Location: Hybrid remote in Durango, CO 81301

Salary : $20 - $22