Accounts Receivable Follow Up Representative

Position Summary 

This role is responsible for timely and effective follow-up on unpaid and underpaid professional billing claims in a high-volume urgent care environment. This role performs claim status verification, denial resolution, appeal generation and submission, identification and recovery of contracted underpayments, and preparation of documentation to support payer projects aimed at resolving claims processing issues. This role plays a critical role in maximizing reimbursement and reducing accounts receivable aging. 

Key Responsibilities 

Claim Status Verification & Follow-Up 

▪ Verify claim status using payer portals, clearinghouses, and direct payer contact. 

▪ Identify reasons for non-payment or delayed payment and take appropriate follow-up actions. 

▪ Document all payer communications, actions taken, and next steps accurately in the billing system. 

Denial Resolution 

▪ Review denied claims to determine root cause and appropriate resolution path. 

▪ Correct billing, coding, eligibility, or documentation issues and resubmit claims as appropriate. 

▪ Collaborate with Billing, Coding, and Clinic Operations teams to resolve preventable denial trends. 

Appeals Generation & Submission 

▪ Prepare, submit, and track appeals for denied or underpaid claims in accordance with payer-specific timelines and requirements. 

▪ Compile required clinical, authorization, and billing documentation to support appeals. 

▪ Monitor appeal outcomes and take follow-up actions as needed. 

Contracted Underpayment Identification & Recovery 

▪ Identify payer underpayments by comparing payments received to contracted reimbursement rates. 

▪ Initiate recovery actions, including appeal submission, payer reprocessing requests, or escalation. 

▪ Track underpayment trends and escalate systemic issues as needed. 

Compliance, Quality & Productivity 

▪ Adhere to payer contracts, CMS regulations, HIPAA requirements, and organizational policies. 

▪ Meet established productivity, quality, and follow-up timeliness standards. 

▪ Participate in quality assurance reviews and required training. 

Collaboration & Continuous Improvement 

▪ Partner with internal teams to resolve issues impacting claim payment. 

▪ Identify recurring payer or workflow issues and communicate improvement opportunities to leadership. 

Required Qualifications 

▪ High school diploma or equivalent required; Associate degree preferred. 

▪ 1–3 years of experience in healthcare accounts receivable follow-up, denial management, or professional billing. 

▪ Working knowledge of payer policies, denial types, appeals processes, and contract-based reimbursement. 

▪ Experience using EHR/practice management systems, clearinghouses, and payer portals. 

▪ Familiarity with California payer requirements and regulatory considerations. 

Preferred Qualifications 

▪ Experience in urgent care or high-volume ambulatory billing environments. 

▪ Certification such as CRCR, CPB, or CPC (or progress toward certification). 

Key Competencies 

▪ Strong analytical and problem-solving skills 

▪ Attention to detail and persistence in follow-up 

▪ Effective written and verbal communication 

▪ Ability to manage high-volume work queues 

▪ Team-oriented and results-driven mindset 

Working Conditions 

▪ Office or remote environment; flexibility for onsite work dictated by business needs 

Reporting Relationship 

▪ Reports to the Supervisor, A/R Follow Up