Billing & ACCOUNTS RECEIVABLE Specialist
Job Description
Department: Billing Department
Reports to:Business Office Manager
Position Summary:The Billing & Accounts Receivable Specialist is responsible for supporting the full revenue cycle for a pediatric neurology practice utilizing eClinicalWorks (ECW) and Waystar. This position focuses on timely claim submission, accounts receivable follow-up, denial management, payment posting, daily reconciliation, patient billing, and insurance collections.
The ideal candidate possesses a strong knowledge of medical billing regulations, payer requirements, and revenue cycle management processes. This individual must be detail-oriented, skilled in problem-solving, and capable of working independently while collaborating with providers, front office staff, credentialing personnel, and management to maximize reimbursement and maintain clean claims.
Required Education and Experience:
- High school diploma or equivalent required.
- Medical Billing and Coding coursework preferred.
- Minimum one year of medical billing, accounts receivable, or revenue cycle experience preferred.
- Experience working with electronic health records and practice management systems; eClinicalWorks experience strongly preferred.
- Experience with clearinghouse systems and electronic claims submission; Waystar experience preferred.
- Working knowledge of ICD-10-CM, CPT, and HCPCS coding.
- Understanding of commercial insurance, Medicaid, and managed care plans.
- Pediatric specialty billing experience preferred.
Essential Skills and Competencies:
Revenue Cycle Knowledge
- Thorough understanding of claim submission, payment posting, denial management, and accounts receivable workflows.
- Knowledge of timely filing requirements and payer-specific billing guidelines.
Analytical and Problem-Solving Skills
- Ability to investigate unpaid, underpaid, denied, and rejected claims.
- Ability to identify root causes of reimbursement issues and recommend solutions.
Attention to Detail
- Maintains accuracy when entering charges, posting payments, reviewing EOBs/ERAs, and documenting account activity.
Organization and Time Management
- Effectively prioritizes daily claims processing, aging account work queues, reconciliation activities, and follow-up tasks according to the Business Office Manager’s guidelines.
Communication Skills
- Professionally communicates with patients, physicians, insurance payers, and internal staff.
- Documents all account activity thoroughly and accurately within ECW.
Team Collaboration
- Works collaboratively with providers, front office personnel, authorization teams, credentialing staff, and management to resolve billing issues.
Essential Job Responsibilities:
Claims Processing and Submission
- Review and verify completed encounters for billing readiness.
- Submit electronic claims through eClinicalWorks and Waystar in a timely manner.
- Monitor claim status and correct claim edits, rejections, and clearinghouse errors.
- Ensure claims meet payer-specific requirements prior to submission.
- Assist with medical record and documentation attachment workflows when required by payers.
Accounts Receivable Follow-Up
- Manage assigned accounts receivable work queues and aging accounts.
- Follow up on unpaid claims through payer portals, phone calls, correspondence, and online resources.
- Prioritize aging balances, including claims exceeding 90, 120, and 180 days.
- Investigate claim delays, medical records requests, coordination of benefits issues, and eligibility concerns.
- Document all collection efforts and payer communications within ECW.
Denial and Appeals Management
- Review insurance denials and identify trends affecting reimbursement.
- Prepare and submit corrected claims, reconsiderations, and appeals with supporting documentation.
- Research payer policies, coding requirements, medical necessity guidelines, and billing regulations to support appeals.
- Collaborate with management and providers to address recurring denial patterns.
Payment Posting and Reconciliation
- Post insurance and patient payments accurately and timely.
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
- Process payment adjustments in accordance with payer contracts and practice policies.
- Participate in daily reconciliation of posted payments, deposits, and bank activity.
- Assist with the preparation and maintenance of daily reconciliation reports and supporting documentation.
Patient Billing and Customer Service
- Assist patients with billing questions and account balances.
- Discuss payment options and payment arrangements consistent with practice policies.
- Generate and monitor patient statements.
- Communicate professionally and compassionately with families regarding financial responsibilities.
Coordination of Benefits and Insurance Verification Support
- Perform patient outreach related to coordination of benefits, demographic updates, and insurance-related corrections.
- Document all outreach attempts in accordance with departmental procedures.
- Assist in resolving eligibility, subscriber information, and coverage discrepancies.
Revenue Cycle Improvement
- Identify workflow issues affecting reimbursement and recommend process improvements.
- Participate in billing meetings, training, and revenue cycle initiatives.
- Maintain knowledge of payer updates, regulatory changes, coding guidelines, and reimbursement trends.
- Assist with cleanup of aging accounts, legacy balances, credit balances, and special projects as assigned.
Documentation and Compliance
- Maintain accurate and complete documentation of all billing activities.
- Follow HIPAA and patient confidentiality requirements.
- Comply with all payer, federal, state, and organizational billing regulations.
- Adhere to established department policies, standard operating procedures, and quality standards.
Performance Expectations:
- Claims submitted promptly following provider documentation completion.
- Payments posted accurately and reconciled daily.
- Assigned accounts receivable work queues maintained and actively worked.
- Denials and rejections addressed within established departmental timeframes.
- Thorough documentation of all follow-up activity maintained in ECW.
- Positive contribution toward AR reduction, denial prevention, and collection goals.
- Demonstrates initiative in identifying and resolving revenue cycle issues.
Physical Requirements:
- Extended periods of sitting and computer work.
- Frequent keyboarding and use of office technology.
