Medical Accounts Receivable Billing Specialist

The Position

The Medical Accounts Receivable Billing Specialist, reporting directly to the Revenue Cycle Manager, is responsible for managing and resolving insurance and patient accounts receivable, and ensuring accurate and timely billing, reimbursement, and collections. This role supports the financial health of WACBD by monitoring outstanding balances, communicating with patients and payers, and maintaining meticulous documentation in accordance with organizational policies and healthcare regulations.

This position requires strong analytical skills, attention to detail, and a commitment to delivering exceptional service to patients with chronic and complex medical needs.

Key Responsibilities

Accounts Receivable & Collections

·         Accurately post all payments, adjustments, and denials to patient accounts daily within the automated billing system (R2), ensuring precise and reconciled financial record-keeping.

·         Actively track unpaid claims and manage aging reports

·         Proactively review and resolve outstanding accounts receivable, including timely follow-up on claims, denials, and underpayments to maximize reimbursement for services provided.

·         Initiate appeals, submit supporting documentation, and track progress to ensure accurate reimbursement.

·         Identify and evaluate outstanding claims to determine when corrections are needed and supply the biller with complete, accurate information required for proper rebilling, including updates to coding, NDC units, modifiers, prior authorizations, and payer‑specific guidelines relevant to hemophilia and specialty infusion services.

·         Process patient statements, payment plans, and financial assistance workflows in compliance with organizational policies. 

·         Collaborate with pharmacy, nursing, and care coordination teams to ensure complete and accurate claim documentation.

·         Conduct thorough verification of healthcare charges against established rates for diagnoses, treatments, services, and supplies, utilizing appropriate CPT, ICD-10, and HCPCS coding to facilitate efficient insurance reimbursement.

·         Analyze remittance advice forms and explanation of benefits (EOB) statements to ensure correct payments from insurance carriers and identify any discrepancies or underpayments.

·         Monitor and manage claim rejections and denials at the clearinghouse and payer levels, identifying root causes and implementing corrective actions promptly.

Patient & Payer Communication

·         Serve as a primary resource for patients with questions regarding billing, balances, and insurance explanations of benefits (EOBs).

·         Communicate professionally with insurance representatives to resolve claim issues and verify claims status.

·         Provide clear, empathetic support to patients navigating complex specialty care billing environments.

Compliance & Documentation

·         Proactively stay informed about changes in payer policies, coding guidelines, and federal and state medical billing regulations to ensure ongoing compliance.

·         Identify opportunities to streamline billing workflows and contribute to the development of internal billing process improvements and training materials for billing staff.

·         Maintain accurate and timely documentation of all account activities in the electronic health record and billing systems.

·         Ensure compliance with HIPAA, federal billing regulations, payer guidelines, and organizational policies.

·         Participate in internal audits, quality improvement initiatives, and process optimization projects.

·         Other duties assigned

Qualifications

·        Specialized Expertise: Active CPC or CPB certification is strongly preferred. In the absence of certification, an Associate’s degree in Healthcare Management, Finance, or Business is required.

·        Core Experience: Minimum of three (3) years of hands-on experience in medical accounts receivable (A/R), specifically managing claim follow-up, denials, appeals, and payment posting.

·        Alternative Path: A minimum of five (5) years of high-level, direct experience in medical billing and A/R may be accepted in lieu of a degree or certification.

·        In-depth knowledge of medical terminology, CPT, ICD-10, and HCPCS coding principles.

·        Strong understanding of insurance payer policies, guidelines, and regulations for commercial, government (Medicare/Medicaid), and third-party payers.

·        Proficiency in fiscal recordkeeping using automated billing systems and general accounting principles relevant to healthcare billing.

·        Solid understanding of state and federal collection laws, regulations, and ethical collection techniques.

·        Proficient in Microsoft Office Suite (Word, Excel, Outlook).

·        Exceptional analytical and problem-solving skills, with meticulous attention to detail.

·        Strong organizational skills with the ability to manage multiple priorities and meet deadlines in   a fast-paced environment.

·        Ability to work under minimal supervision with the ability to execute independent judgement and sound decision making.

·        Ability to elicit and evaluate information, sometimes of a highly personal and sensitive nature, from a broad spectrum of individuals and agencies maintaining confidentiality.

·        Ability to read, interpret, and apply regulations, policies, and procedures

·        Experience with R2, NewLeaf or related Pharmacy Billing software desired.

·        Experience with NextGen or related EMR/EHR software.

·        Ability to maintain confidentiality per HIPAA requirements

·        Required physical activities while using a laptop include frequent sitting, talking, hearing, and repetitive motions of hands/wrists

·        Required physical activities used less frequently include standing, walking, and reaching, kneeling, bending, and stooping

·        Attend collaborative meetings and organizational retreats.