Description:
Reporting to the Revenue Cycle Manager, the Insurance Accounts Receivable (A/R) Specialist will support the organization’s revenue cycle operations. This role is responsible for the timely follow-up and resolution of outstanding insurance claims across Medicaid and commercial payers, ensuring accurate reimbursement and minimizing aged receivables.
The A/R Specialist will conduct detailed account analysis, address claim denials and underpayments, and collaborate with internal teams to identify and resolve barriers to payment. This position requires a strong understanding of payer guidelines, attention to detail, and the ability to manage a high-volume work queue while maintaining quality and compliance standards.
Essential Functions, Duties and Responsibilities
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Perform timely and thorough follow-up on assigned insurance A/R accounts (Medicaid and commercial)
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Analyze and resolve claim denials, rejections, and underpayments in accordance with payer policies and contractual requirements
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Initiate and track appeals, corrected claims, and reconsiderations through final resolution
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Utilize payer portals and direct payer communication channels to obtain claim status and facilitate resolution
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Identify trends and root causes impacting reimbursement and escalate systemic issues as appropriate
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Maintain accurate, detailed, and audit-ready documentation of all account activity
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Collaborate with front-end, coding, and billing teams to resolve upstream issues affecting claims adjudication
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Prioritize workload effectively to address aging accounts and high-dollar balances
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Consistently meet established productivity, quality, and timeliness benchmarks
Requirements:
Knowledge, Skills and Abilities
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Experience with eClinicalWorks (eCW)
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Prior experience in an FQHC or community health center setting
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Familiarity with payer denial trends and reimbursement regulations impacting healthcare organizations
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Timely and consistent resolution of assigned A/R inventory
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Reduction in aged receivables, particularly accounts over 90 days
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Demonstrated ability to independently move accounts toward resolution
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High-quality, compliant, and audit-ready documentation
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Consistent achievement of productivity and quality benchmarks
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Proven ability to independently manage a high-volume A/R inventory
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Strong analytical, organizational, and problem-solving skills
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Effective written and verbal communication skills, including payer interaction
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Proficiency with payer portals and revenue cycle systems
Education, Training and Experience
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Minimum of 2 years of experience in insurance A/R follow-up within a healthcare setting
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Demonstrated experience resolving denials and appeals through to completion, not solely performing status checks
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Working knowledge of:
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Medicaid (New Jersey experience preferred)
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Commercial payer reimbursement methodologies and denial processes
