AR Follow Up Specialist

360care; Detroit (MI); On-site; USD 38,000 - 52,000; Full time

Job summary

360care is seeking a medical billing specialist in Detroit, MI to ensure timely follow-up on denied or pending claims. The role emphasizes researching denials, posting adjustments, and communicating with facilities and families to resolve accounts.

The ideal candidate has 1+ year experience in a medical office, knowledge of HMO/PPO/Medicare/Medicaid, and familiarity with billing software and EMR systems. Strong accuracy and confidentiality are essential.

Qualifications

• High school diploma or GED.
• Associate degree in Business Administration, Accounting or Health Care Administration preferred.
• 1+ years in a medical office setting.
• 1+ years of HMO/PPO, Medicare and Medicaid experience required.
• 1+ years of accounting and bookkeeping procedures.
• 1+ years of medical terminology.

Responsibilities

• Follow up on denied, pending, or remittance-requiring claims with payers.
• Research and appeal denied claims to ensure timely payment.
• Rebill services for nursing home patients (dental, podiatry, audiology, etc.).
• Post adjustments and payments accurately in the billing system.
• Verify eligibility and benefits for patients and providers.
• Prepare and transmit claims electronically and on paper as needed.
• Maintain confidentiality in compliance with HIPAA/PHI rules.
• Respond to inquiries from facilities, patients, and staff in a professional manner.

Skills

Communication skills

Customer service

Teamwork

Problem solving

Education

High school diploma or GED

Associate degree in Business Administration/Accounting/Health Care Administration

Tools

Billing software

EMR system

Job description

Overview

This position is responsible for the timely follow up of technical or professional medical claims to insurance companies that have been denied, left pending or require remittance. Working aged receivable reports; identify errors and work claims, calling insurance companies if necessary and posting adjustments and payments as well.

Responsibilities

• Working overpayment report by identifying refunds due to patient or insurance company and process request.
• Research and appeal denied claims.
• Responsible for rebilling of services provided to nursing home patients (dental, podiatry, audiology and optometry).
• Responsible for EMR system
• Responsible for posting procedures/modifiers/Dx codes verify for accuracy (providers choose codes, we verify and submit claims out to insurance company), verify insurance accuracy before submitting, working reports for missing charges from providers at a minimum of weekly basis.
• Answering incoming phone calls from facilities, patient or patient's family and field staff about account inquiries.
• Maintaining and enhancing knowledge through further education provided by self, other staff or training on our computer via self-guided modules.
• Mailing out own correspondence/claims as printed on a daily/weekly basis as needed.
• Check eligibility and benefit verification.
• Review patient bills for accuracy and completeness and obtain any missing information.
• Prepare, review and transmit claims using billing software, including electronic and paper claim processing.
• Follow up on unpaid claims within standard billing cycle time frame following prescribed methods.
• Updates cash spreadsheet
• Expected to work 450+ encounters per week
• Actively supports and complies with all components of the compliance program, including, but not limited to, completion of training and reporting of suspected violations of law and Company policy.
• Maintains confidentiality of all information; abides with HIPAA and PHI guidelines at all times.
• Reacts positively to change and performs other duties as assigned.

Qualifications

• High school diploma or GED
• Knowledge of business and accounting process usually obtained from an Associates in Business Administration, Accounting or Health Care Administration required.
• 1+ years in a medical office setting.
• 1+ years of HMO/PPO, Medicare and Medicaid, and other payment requirements and systems required.
• 1+ years of accounting and bookkeeping procedures required.
• 1+ years of medical terminology required.
• Must be able to work well under pressure with hard deadlines

Minimum Qualifications:

• Use of computer systems, software and calculator.
• Effective communication abilities for phone contacts with insurance payers to resolve issues.
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Able to work in a team environment.
• Problem-solving skills to research and resolve discrepancies, denials, appeals and collections.

We will only employ those who are legally authorized to work in the United States. Any offer of employment is conditional upon the successful completion of a background investigation and drug screen.

We are an equal opportunity employer.