Accounts Receivable Specialist

HighFive Healthcare; Birmingham (AL); On-site; USD 36,000 - 60,000; Full time

Job summary

HighFive Healthcare is seeking an Accounts Receivable Specialist to manage the Oral Surgery insurance AR process, submit claims timely, and follow up on denials. The role collaborates with payors and patients to resolve billing discrepancies.

Experience in denial management and healthcare billing is required. Ideal candidates have 2+ years in healthcare billing, familiarity with EHR systems, and strong attention to detail.

Qualifications

• Oral Surgery billing experience required.
• Denial/Claim or AR experience with TMJ or related procedures preferred.
• Minimum of 2 years of healthcare billing and accounts receivable.
• Knowledge of medical insurance plans, billing procedures, and reimbursement processes.
• Proficiency with EHR systems and billing software.
• Working knowledge of Excel and system workflows.
• Strong attention to detail and accuracy in claims processing.
• Excellent communication and problem-solving skills.

Responsibilities

• Investigate, appeal, and resolve denied or rejected claims by insurance payors.
• Review and assess EOBs to determine issues at the claim level.
• Determine root cause of billing issues to prevent recurrence.
• Make corrections to claims and rebill using standardized processes.
• Follow up with unresolved claims via system resources, clearinghouse, payer portal, or calls.
• Assess if an appeal is required and track appeals for timely payment.
• Spot recurring denial patterns and report to management.
• Communicate effectively with team members, payors, patients, and others.
• Stay updated on internal processes, industry standards, and regulations.
• Participate in special projects or additional duties as needed.
• Meet or exceed daily accounts to satisfy HighFive and provider expectations.
• Contribute to net collection rate goals and resolution of denied claims.

Skills

Oral Surgery billing

Denial management

EHR systems

Billing software

HIPAA compliance

Excel

Communication skills

Independent work

Problem solving

Education

High school diploma

Healthcare/business degree preferred

Tools

Billing software

Job description

Description

The Accounts Receivable Specialist is responsible for managing HighFive's Oral Surgery insurance accounts receivable process. This role involves the timely and accurate submission of claims, following up on unpaid and denied claims, and working with insurance companies. We are looking for specific Oral Surgery billing experience. The accounts receivable representative will also work closely with healthcare payors or patients to resolve any billing discrepancies or issues. The goal is to exceed HighFive's net collection rates and reduction of aging receivable as established by the RCM management team.

Responsibilities

• Investigate, appeal, and resolve denied or rejected claims by insurance payors. Work with insurance companies to clarify discrepancies and ensure proper reimbursement.
• Review and assess Explanation of Benefits (EOBs) at the claim level to determine issues.
• Determine root cause of any billing related or claim submission issues to prevent recurrence.
• Make corrections to claims based on denials and rebill utilizing standardized process and procedures.
• Follow up with unresolved claims through system resources, clearinghouse, payer portal or call to the payor, when necessary.
• Assess whether an appeal is required for a claim denial. Track appeals to ensure timely payment and resolution.
• Spot recurring patterns in denials and report them to management for further analysis and action.
• Effectively communicate both verbally and in writing with team members, payors, patients, and other relevant parties.
• Keep up to date with internal processes, industry standards, and government regulations relevant to denial management to ensure compliance and best practices.
• Participate in or take on special projects or additional duties as required by the team or management.
• Meet or exceed required accounts per day to meet HighFive and provider's expectations.
• Achieve department goals for net collection rates and the resolution of denied claims, including those successfully paid or overturned.

Requirements

• Oral Surgery billing experience required.
• Denial/Claim OR AR Experience with TMJ (temporomandibular joint/orthognathic surgery) preferred.
• High school diploma or equivalent; associate or bachelor's degree in healthcare, business, or a related field preferred.
• Minimum of 2 years of experience in healthcare billing and accounts receivable.
• Knowledge of medical insurance plans, billing procedures, and healthcare reimbursement processes.
• Proficiency with Electronic Health Record (EHR) systems and billing software.
• Dental billing experience preferred but not required.
• Working knowledge of excel and system workflows.
• Prior experience with mid or large-scale healthcare business office of 100 or more providers preferred.
• Strong attention to detail with the ability to accurately review and process claims.
• Excellent communication and problem-solving skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Knowledge of HIPAA and other healthcare compliance regulations.