About this role
We are seeking an Accounts Receivable (A/R) Claims Specialist to join our Revenue Cycle team.
In this role, you’ll help keep our revenue cycle moving by managing insurance claims from submission through resolution. You’ll investigate unpaid and denied claims, work directly with insurance payers, resolve discrepancies, and ensure patient accounts accurately reflect current balances and payment activity.
Join Our Team
This is an opportunity to play an important role in the financial health of a growing healthcare organization while developing your expertise in medical claims, insurance follow-up, denials, appeals, and revenue cycle management.
If you’re detail-oriented, persistent, and enjoy figuring out why a claim hasn’t paid and what needs to happen next, this could be a great fit.
What You'll Do
Submit electronic insurance claims accurately and within established filing requirementsReview electronic claim reports for errors and correct and resubmit rejected claimsConduct timely follow-up on unpaid, underpaid, rejected, and denied claims through payer portals, phone calls, and written correspondencePrepare and submit claim reconsiderations, corrected claims, and appeals when appropriateReview and process Explanations of Benefits (EOBs) and payer responsesInvestigate outstanding accounts receivable balances and take appropriate action to facilitate paymentReview A/R reports regularly to identify aging claims, payment delays, denials, and other outstanding balances requiring follow-upResearch claim issues including missing documentation, coding or billing errors, eligibility concerns, authorization discrepancies, and payer requirementsMaintain patient ledgers in Platinum Patient Accounting Software to ensure balances and account activity are accurate and currentDocument all claim follow-up activity, payer correspondence, status updates, and next steps clearly within the billing systemEscalate recurring payer issues or complex claims when additional review is neededCollaborate with internal billing, clinic, and revenue cycle team members to obtain information needed for claim resolutionHelp identify trends contributing to denials or delayed reimbursement and support efforts to improve clean-claim and collection performanceBenefits
Compensation Perks:
Bi -Weekly pay cycle.401(k) Retirement Savings Program with employer discretionary matching.Health & Wellness Perks:
Medical, dental, and vision insurance.Life and disability insurance options.Work-Life Balance:
Paid time off (holidays, vacation, sick days).Schedule: Monday-Thursday, 8am-4pm and Friday 7am-1pm 2 years’ experience in insurance billing & collections related field preferredPrevious experience in medical billing, insurance claims, accounts receivable, or revenue cycle management strongly preferredWorking knowledge of insurance claim submission, denials, appeals, EOBs, and payer follow-upExperience navigating insurance payer portals and communicating directly with insurance companiesUnderstanding of healthcare reimbursement and A/R aging preferredStrong investigative and problem-solving skills with the ability to determine the root cause of unpaid or denied claimsHigh attention to detail and accuracy when reviewing patient accounts and claim informationStrong organizational and time-management skills with the ability to manage a high-volume claim workloadClear written and verbal communication skillsComfortable learning and working within multiple billing systems and payer platformsExperience with Platinum Patient Accounting Software is a plus, but not requiredExperience with Waystar #ZR
Disclaimer
All team members agree to consistently support compliance and TVG-Medulla, LLC policies and Standards of Excellence with regard to maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and Medulla procedures and protocols. Must perform other related duties and assist with project completion as needed. Team member may be required to provide necessary information to complete a DMV (or equivalent agency) background check.