Accounts Receivable Specialist - Medical Billing

Yosemite Pathology (YP) is a private independent pathologist owned and operated surgical pathology and cytology laboratory based in Modesto, CA. YP provides comprehensive state of the art, reliable, and accurate diagnostic services to its physicians and major area hospitals in the Alameda, Amador, Calaveras, Contra Costa, Kern, Mariposa, Merced, San Joaquin, Solano, Stanislaus and Tuolumne counties.

YP offers a full spectrum of tissue pathology, cytology and histology services, including examination of gynecologic specimens, body fluids and fine needle aspiration specimens. We also offer an extensive array of special stains and immunohistochemistry to assist in the management of oncologic and non-oncologic diseases. The laboratory is supported by highly qualified Histotechnologist, Cytotechnologist, Technicians and office staff who offer excellent service.

Summary/Objective

The Accounts Receivable (A/R) Specialist plays a critical role in integrating billing and revenue cycle best practices to ensure timely reimbursement for all payor groups, including contracted, non-contracted, and government payors. This position focuses on claims processing, managing accounts receivable, and addressing low pay claims, denials, payment discrepancies, and appeals. The successful candidate will be responsible for ensuring accurate billing, timely follow-up on outstanding accounts, and adherence to industry standards and payor requirements to optimize revenue cycle efficiency. This role requires a strong understanding of medical billing, coding practices, and healthcare regulations, along with a high attention to detail and excellent communication skills.

Shift: Monday - Friday 7:30 am - 4:00 pm (one hour flex time to start no later than 8:30am)

Essential Functions

• Answer and direct incoming phone calls professionally and efficiently.
• Respond to voicemails, emails, and other messages in a timely manner.
• Investigate denied claims promptly by researching the cause, taking appropriate corrective action, and submitting appeals as needed to maximize reimbursement.
• Review and submit corrected claims, ensuring all required information is accurate and complete to facilitate proper payment.
• Maintain assigned accounts and work queues within established departmental timeframes and productivity expectations.
• Meet or exceed established key performance indicators (KPIs) related to accounts receivable, claims follow-up, denials management, and collections.
• Process error claims and no-activity accounts in a timely manner to prevent delays in reimbursement.
• Communicate with hospitals, physician offices, insurance carriers, and other entities to obtain missing information needed for claim resolution.
• Forward qualifying accounts to third-party collection agencies in accordance with company policies and procedures.
• Maintain strict compliance with HIPAA and all applicable privacy and security regulations, including when accessing client and payer portals.
• Adapt positively to departmental changes and support continuous process improvement initiatives.
• Collaborate with team members to improve collections performance, identify issues, and implement effective solutions.
• Support internal and external audits by providing requested documentation and assisting with the resolution of audit findings.
• Perform other duties and responsibilities as assigned.

Job Requirements and Skills

• High school diploma or equivalent required.
• Minimum of 2 years of medical billing experience required; pathology billing experience preferred.
• Strong attention to detail with the ability to maintain accuracy while demonstrating a positive and proactive attitude.
• Excellent customer service skills and professional phone etiquette.
• Strong analytical and problem-solving skills with the ability to identify billing errors, resolve discrepancies, and ensure data accuracy.
• Excellent written and verbal communication skills.
• Ability to effectively manage multiple priorities in a fast-paced, high-volume environment.
• Proficiency with Revenue Cycle Management (RCM) software, Electronic Health Record (EHR)/Electronic Medical Record (EMR) systems, Microsoft Office Suite (particularly Excel), and payor portals/websites.
• Ability to perform repetitive tasks with a high degree of accuracy and consistency.
• Ability to establish and maintain effective, professional working relationships with team members, providers, clients, and external partners.
• Strong organizational and time management skills with the ability to meet established productivity and quality standards.
• Ability to work independently while contributing to a collaborative team environment.

Compensation and Benefits:

• The compensation range is $47,840 - $56,160 annually (non-exempt) paid semi-monthly on an eight (8) hour per day, forty (40) hour per week. Final salary offer subject to multiple factors including candidate experience and expertise, geographic location of the role, and current market data.
• 401(k) includes an employer match up to 4%
• Robust health plans including dental, vision, life, and mental health support.
• Offer generous annual vacation and sick time
• 10 paid holidays
• Annual scrub allowance for Lab roles