Accounts Receivable Specialist

Talentify; Riverside (CA); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Challenging work

Growth opportunities

Competitive compensation

Job summary

Riverside Medical Clinic is seeking a claims billing specialist to accurately process fee-for-service claims and manage account collections. You will work under supervision to review tracer claims, initiate appeals, and ensure timely submissions.

You will analyze denied claims, communicate with insurers, stay current with billing regulations, and document all interactions. This role requires organizational skills and attention to detail in a mission-driven hospital setting.

Qualifications

• High school diploma and knowledge of medical terminology.
• Two years or more in medical billing/collections is required.
• Strong attention to detail and accuracy in coding and posting payments.

Responsibilities

• Assist the supervisor as requested.
• Review, adjust, and mail out all assigned tracer claims.
• Initiate claim review and/or appeals as indicated on assigned Explanation of Benefits.
• Review, adjust, and process all assigned correspondence.
• Work aging AR: contact insurer to check status; verify benefits and coverage; initiate adjustments or refunds.
• Analyze and investigate denied claims to determine root causes, including coding errors and missing information.
• Prepare and submit appeals for denied claims with payer requirements in mind.
• Resubmit corrected claims with documentation and follow up for timely processing.
• Communicate with insurance companies and payers to resolve denials and gather information for appeals.
• Maintain regular follow-up on appealed claims and escalate as needed to resolve.
• Stay informed about billing regulations and payer policies to ensure compliance.
• Manage and resolve claims with pending responses and track unpaid claims.
• Document all interactions and actions taken.
• Maintain professional attitude in performance and appearance.

Skills

Medical terminology

Billing/collections

Attention to detail

Education

High school diploma

Job description

Responsibilities

Come and join the RMC Family!

We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

Website: https://www.riversidemedicalclinic.com/

SUMMARY:

Responsible for the accurate and timely processing of fee-for-service claims and account collections.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS:

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: Other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing.

1. Assist the supervisor as requested.

2. Review, adjust, and/or mail out all assigned tracer claims

3. Initiate claim review and/or appeals, as indicated on assigned explanation of benefits.

4. Review, adjust, and/or process all assigned correspondence.

5. Work aging AR:
a. Contact insurance carrier to check on claim status and/or responsible party to settle account.
b. Review Explanation of Medical Benefits to verify accuracy of reimbursement
c. Verify insurance coverage
d. Initiate necessary account adjustments, change of charges and/or refunds as indicated.

6. Analyze and investigate denied claims to determine the root cause of denials, including coding errors, missing information, and billing discrepancies.
7. Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements and regulations to maximize the likelihood of successful resolution.
8. Resubmit corrected claims with the appropriate documentation and follow up to ensure timely processing.
9. Communicate with insurance companies, payers, and other relevant parties to resolve denials and obtain information needed for appeals and/or resubmission.
10. Maintain regular follow-up with insurances and responsible parties to track the progress of appealed claims and pending actions. Escalate as necessary to achieve successful resolution.
11. Stay informed about industry changes, billing regulations, and payer policies to ensure compliance with applicable laws and best practices.
12. Manage and resolve claims with pending responses from insurance companies and/or other parties.
13. Track and follow up on unpaid claims and/or incomplete documentation.
14. Review account with no response and communicate with relevant parties to obtain necessary information
15. Document all interactions and actions taken.
16. Display a professional attitude through performance, appearance, and demeanor.

This opportunity offers the following:

• Challenging and rewarding work environment
• Growth and Development Opportunities within UHS and its Subsidiaries
• Competitive Compensation

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

EDUCATION and/or EXPERIENCE: High school diploma or general education degree required. Knowledge of medical terminology required. Two years prior experience in medical billing/collections is REQUIRED.

CERTIFICATES, LICENSES, AND REGISTRATIONS:

None.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.