RCM Specialist

Infinit-O; Pasay; Remoto; PHP 450.000 - 750.000; Tempo pieno

Descrizione del lavoro

Infinit-O is recruiting an Accounts Receivable Specialist for a remote role serving US healthcare clients. You will actively manage claim collections, reduce denials, and improve cash flow by following up aged claims and resolving issues. Strong RCM knowledge, payer portal usage, and accurate documentation are essential.

You will analyze EOBs, prepare appeals with clinical documentation, and communicate with payers to negotiate outcomes. This role requires persistence and attention to detail.

Competenze

• Experience in US Healthcare RCM AR follow-up and denial management.
• Familiarity with EOBs, RAs, and denial codes.
• Strong analytical and negotiation skills.
• Excellent communication with payers.
• Ability to meet aging targets and collection goals.

Mansioni

• Follow-up on aged insurance claims and prioritize by value.
• Analyze EOBs, RA, and denials to determine root causes.
• Prepare and submit appeals with supporting clinical documentation.
• Proactively contact payers to check status and negotiate resolutions.
• Identify and recover underpayments or below-contracted amounts.
• Document denial trends and provide process-improvement feedback.
• Maintain billing notes and generate AR performance reports.

Conoscenze

RCM systems

Payer portals

Analytical skills

Verbal/written comms

Results oriented

Formazione

High school diploma

Associate's or Bachelor's degree (preferred)

Strumenti

Availity

Navinet

Descrizione del lavoro

Infinit-O is the trusted customer-centric and sustainable leader in Business Process Optimization for Small and Medium businesses in the Financial Services, Healthcare, and Technology sectors by delivering continuous improvement through technology, data, and people.

Job Description

This is a remote position.

Infinit-O is the trusted, customer-centric, and sustainable leader in Business Process Optimization. We empower finance and healthcare organizations to thrive in a digital-first world by combining specialized industry expertise and innovative technology for 20 years.
We navigate complex industry landscapes to drive transformative outcomes, helping businesses streamline operations, enhance customer experience, and achieve sustainable growth backed by a world-class Net Promoter Score of 75. Our approach combines operational efficiency with a human-centered ethos, ensuring sustainable value creation for our clients and team members.
As a Certified B Corporation, Infinit-O is committed to the highest standards of social and environmental performance, accountability, and transparency. We embed these values into every aspect of our operations-aligning business success with a positive impact on our clients, people, and communities.
Our commitment to Diversity, Equity, and Inclusion (DEI) is integral to our mission. We believe that building inclusive, equitable teams is not only the right thing to do—it is also essential for driving innovation and better business outcomes. We actively promote equal opportunity through inclusive hiring practices, continuous learning programs, and regular equity assessments to ensure a fair and empowering workplace for all.

Summary

The Accounts Receivable (A/R) Specialist is a critical role responsible for actively managing the collection of outstanding claims and resolving all payment denials. This position directly impacts the client’s cash flow and revenue realization by ensuring all legitimate claims are paid quickly and accurately.

Key Responsibilities

• A/R Follow-Up: Systematically review and follow up on outstanding insurance claims that have aged beyond standard payment cycles, prioritizing accounts based on value and age.
• Denial Analysis & Resolution: Analyze Explanation of Benefits (EOB), Remittance Advices (RA), and denial codes to determine the root cause of non-payment.
• Appeals Management: Prepare and submit well-researched, customized appeals to payers for denied claims (e.g., medical necessity, lack of authorization, timely filing) using appropriate supporting clinical documentation and payer-specific guidelines.
• Payer Communication: Proactively contact insurance companies (via phone, website portals, or written correspondence) to check claim status, challenge underpayments, and negotiate resolution for complex A/R issues.
• Underpayment Review: Identify and investigate claims paid incorrectly or below contracted rates, initiating the necessary steps to recover the difference.
• Trend Identification: Document and elevate denial trends, coding issues, or payer process changes to management and the billing team to facilitate process improvement and prevention of future denials.
• Reporting: Maintain detailed documentation of all follow-up and denial resolution steps in the billing system notes. Generate A/R performance reports as required.

Requirements

• Job Requirements and Credentials:
• Education: High School Diploma or equivalent required. Associate's or Bachelor's degree in a relevant field preferred.
• Experience: Minimum 2-3 years of dedicated experience in Accounts Receivable follow-up and denial management within US Healthcare RCM.
• Technical Skills: Advanced proficiency in RCM/Practice Management Systems. Expert use of payer portals (e.g., Availity, Navinet) for claims status and eligibility. Strong knowledge of EOBs, RAs, and standard denial/adjustment codes.
• Excellent critical thinking and analytical skills to interpret complex denial reasons.
• Strong written and verbal communication skills for effective payer negotiations and professional appeals drafting.
• Results-oriented and highly persistent in follow-up.
• Other Proven ability to meet strict A/R aging and collection targets. Thorough understanding of the insurance appeals process across major payer types.