Department
Revenue Cycle
Reports To
Revenue Cycle Manager
Location
Warren, OH (on-site)
FLSA Status
Full-Time, Non-Exempt
Compensation
$20–$24 per hour, commensurate with experience
Position Summary
The Accounts Receivable Specialist owns the follow-up and resolution of outstanding insurance and client balances across all payers and service lines. This is a production role with measurable output expectations: working assigned claim queues daily, resolving denials and underpayments, pursuing aged balances before timely-filing deadlines, and documenting every account touch in the EHR. The Specialist works within a co-sourced revenue cycle model alongside our external billing partner and is accountable for the accounts assigned to them from first follow-up through final resolution.
Essential Duties & Responsibilities
- Claim follow-up. Work assigned A/R follow-up queues daily in the EHR (CareLogic/Qualifacts), prioritizing by balance, age, and timely-filing risk.
- Denial resolution. Research and resolve denied, rejected, and underpaid claims; identify root cause (eligibility, authorization, coding, COB, duplicate submission, payer routing) and take corrective action through resubmission, reconsideration, or appeal.
- COB management. Identify and resolve coordination-of-benefits issues, including obtaining updated primary/secondary payer information and rebilling in correct order before filing deadlines lapse.
- Timely filing. Track payer-specific timely-filing and appeal deadlines for Ohio Medicaid, Medicaid managed care/MyCare plans, Medicare, and commercial payers; escalate at-risk balances to the Revenue Cycle Manager before deadlines pass, not after.
- Payer contact. Contact payers by portal and phone to verify claim status, eligibility, and authorization; document reference numbers, representative names, and next actions on every call.
- Documentation. Document every account touch in the EHR with a clear note stating what was found, what was done, and the follow-up date. Undocumented work is treated as work not performed.
- Payment reconciliation. Review remittances and EOBs to reconcile payments against expected reimbursement; flag underpayments, incorrect capitation routing, and recoupments for escalation.
- Billing partner coordination. Coordinate with the external billing partner on claim corrections, resubmissions, and escalations; respond to partner requests within one business day.
- Aging management. Generate and work aging reports; contribute to monthly A/R review with accurate status on assigned accounts, including collectability assessment and recommended write-offs with supporting documentation.
- Client balances. Handle client balance follow-up professionally and in compliance with company policy, including statements, payment plans, and account questions.
- Compliance. Maintain full compliance with HIPAA and 42 CFR Part 2 in all account activity and communications.
Performance Standards
Performance in this role is measured, reviewed monthly, and tied to continued employment and advancement:
- Minimum daily account touches as set by the Revenue Cycle Manager, with 100% of touches documented in the EHR.
- Zero preventable timely-filing losses on assigned accounts. Balances lost to filing deadlines without a documented escalation are a performance failure, not a payer problem.
- Measurable month-over-month reduction in assigned A/R over 90 days.
- Denials on assigned accounts worked within 5 business days of receipt.
- Accurate, on-time inputs to the monthly A/R aging review.
Qualifications
Required
- 2+ years of medical accounts receivable, insurance follow-up, or medical billing experience.
- Working knowledge of the full claim lifecycle: eligibility, authorization, submission, adjudication, denial, appeal, and payment posting.
- Experience reading and interpreting EOBs/ERAs, remittance advice, and denial codes (CARC/RARC).
- Proficiency with practice management/EHR systems and payer portals; strong Excel fundamentals.
- High school diploma or equivalent.
Preferred
- Behavioral health billing experience, including Ohio Medicaid, Medicaid managed care/MyCare, and behavioral health service codes (H-codes, PHP/IOP).
- CareLogic/Qualifacts experience.
- Experience working in a co-sourced or outsourced billing model.
- Certified Revenue Cycle Representative (CRCR) or similar credential.
Competencies
- Ownership: treats assigned A/R as their responsibility to resolve, not a list to monitor. Closes loops without being chased.
- Persistence: follows accounts through multiple payer contacts and appeal levels until resolved.
- Attention to detail: catches COB order errors, routing issues, and underpayments others miss.
- Time management: consistently hits daily production volume while prioritizing dollar and deadline risk correctly.
- Communication: writes clear account notes and escalates problems early with the facts needed to act.
Work Environment & Physical Requirements
Standard office environment. Prolonged periods sitting at a desk and working on a computer. Occasional lifting up to 15 pounds. Regular, predictable, on-site attendance is an essential function of this position.
Acknowledgment
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Open Water Counseling & Recovery is an Equal Opportunity Employer.
Pay: $20.00 - $24.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
