RCM Billing Claims Specialist- Medical Accounts Receivable Experience

Job Description:

Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals.

Responsibilities

• Gather accurate reimbursement on client accounts and identify denial trends to improve client performance 

• Contact insurance companies by phone, email, fax, and written correspondence to resolve issues that prevent claims from being processed correctly 

• Follow up on outstanding medical A/R with no response from the insurance carriers 

• Review and apply current standards on federal and state regulations and statues that influence collections of receivables and meet productivity standards 

• Utilize RPA tools and AI-assisted workflows to automate routine claim follow-up tasks and enhance processing efficiency 

• Handle Electronic Data Interchange (EDI) transactions, including reconciling carrier submissions, edits and rejection reports 

Qualifications
Required

• High school diploma or GED. 

• At least 1 year of medical billing experience. 

• At least 1 year of Accounts Receivable experience

• Advanced Microsoft Excel skills including vlookups, pivot tables, and spreadsheet management 

• Strong analytical and problem-solving skills  

• Excellent verbal and written communication skills  

• Demonstrated ability to meet productivity metrics  

• Basic understanding of insurance policies, Medicare, and Medicaid billing requirements 

Preferred

• Knowledge of medical billing specifically in behavioral, homecare, or long-term care insurance. 

• Collections experience in a healthcare setting. 

• Working knowledge of medical billing systems such as Medic, IDX, Avatar, Tier, Medical Manager 

• Experience with or willingness to learn automation tools and AI-powered revenue cycle management systems 

Expectations 

• Comfortable with remote work arrangements and virtual collaboration tools  

• Physical demands include extended periods of sitting, computer use, and telephone communication 

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals....

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

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