Medical Accounts Receivable Specialist

SUMMARY:

This position is responsible for the daily processing and review of claims to Medicare, Medicaid, and other third-party insurance companies in support of the Revenue Cycle department, performed in a fully remote work environment. As an Accounts Receivable Specialist, you will also be responsible for timely follow-up on claims and communicating and working with payers and patients - via phone, email, secure messaging, and patient portals - to resolve their accounts. This role requires the ability to work independently, manage time effectively, and maintain HIPAA-compliant data security while operating outside a traditional office setting.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

(Responsibilities include, but not limited to)

• Reviews claim denials and unprocessed claims as assigned by manager; documents unpaid claims and follow-up actions accurately within the billing/RCM software.
• Works claims and denials queues within the practice management and clearinghouse systems, and monitors payer portals for claim status, remittance advice, and required documentation requests.
• Tracks and trends activity in their specific area, identifying recurring denial patterns and payer issues, and communicates findings and any changes to their Manager.
• Responsible for responding to patient inquiries through multiple remote channels, including phone calls, email, secure messaging, and patient portal correspondence.
• Follows HIPAA guidelines regarding the dissemination of patient information in the billing process, including maintaining a secure, private remote workspace and using company-approved, encrypted systems for all PHI.
• Attains and continuously maintains/expands knowledge of Medicare, Medicaid, and third-party insurance benefits, deductibles, co-pays, and exclusions, as well as specific details relating to the payers assigned to the specialist.
• Provides clear, timely documentation of all activity generated on accounts in their respective areas of responsibility within the billing system.
• Files appeals with supporting documentation as appropriate, including electronic appeal submissions through payer portals where available.
• Utilizes remote collaboration tools (video conferencing, instant messaging, shared dashboards) to stay connected with the billing team and management.
• Maintains reliable availability and responsiveness during scheduled remote working hours, and proactively communicates any connectivity or equipment issues that may affect productivity.
• Performs other duties as required by manager.

KNOWLEDGE AND SKILLS:

• Strong attention to detail and continuous focus on quality.
• Intermediate knowledge of Medicare, Medicaid, and third-party payers, including payer-specific portals and electronic remittance processes.
• Proficient with computers, office equipment, and standard billing/practice management software, as well as remote work technology (VPN, video conferencing, secure messaging, cloud-based document sharing).
• Ability to maintain accurate electronic records and files in a fully digital, remote environment.
• Outstanding written and verbal communication skills, including professional phone and video etiquette.
• Demonstrated ability to work independently, manage time effectively, and stay self-motivated and productive without in-person supervision.
• Experienced professional with outstanding time management and organizational skills.
• Demonstrated knowledge of claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs).
• Experience with accounts receivable functions, including CPT, ICD-10, and HCPCS coding.
• Experience filing and processing appeals for Medicare, Medicaid, or third-party insurance claims, including electronic appeal submission.
• Basic awareness of cybersecurity best practices and data privacy requirements associated with handling PHI outside of a traditional office.

REMOTE WORK REQUIREMENTS:

• Must maintain a dedicated, private, HIPAA-compliant home workspace free from unauthorized access to protected health information (PHI).
• Must have reliable high-speed internet service meeting minimum company-specified bandwidth requirements to support remote billing systems and video conferencing.
• Must use company-approved equipment and security measures, including VPN, multi-factor authentication, and encrypted storage/transmission of billing data.
• Must be available and responsive during designated core business hours and able to attend scheduled virtual meetings with management and other departments.

PHYSICAL REQUIREMENTS:

• Works around standard home-office conditions, with repetitive use of a keyboard at a workstation for extended periods, and use of manual dexterity.
• Must be able to sit for extended periods while working at a computer, and communicate effectively via phone and video conferencing in a remote environment.

MINIMUM QUALIFICATIONS:

• High School Diploma required, Associate Degree preferred.
• Minimum 2 years of experience performing medical billing, medical coding, verification, or accounts receivable management.
• Demonstrated prior success working in a remote or telecommute position preferred.
• Working knowledge of electronic health record (EHR) and practice management systems, payer portals, and clearinghouse platforms.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Allegiance is an EEO employer as defined by the EEOC.