RCM, Account Receivable Specialist

The Revenue Cycle Accounts Receivable Specialist is responsible for managing and resolving outstanding account balances. This includes researching and following up on claim statuses, addressing denied claims, and filing appeals when necessary. The specialist plays a crucial role in ensuring timely payment and reducing aged receivables by effectively handling claim denials and discrepancies.

Responsibilities

• Gather accurate reimbursement on client accounts and identify denial trends to improve client performance.

• Follow up on outstanding medical A/R with no response from the insurance carriers.

• Update client account in system with any action taken or additional information attained when verifying benefits.

• Contact insurance companies by phone, email, fax, and written correspondence to resolve issues that prevent claims from being processed correctly.

• Handle EDI (Electronic Data Interchange) transactions, including reconciling carrier submissions, edits and rejection reports.

• Provide customer service support for patients, client administrative staff and insurance companies

• Review and apply current standards on federal and state regulations and statues that influence collections of receivables and meet productivity standards.

Qualifications
Required

• High school diploma or GED.

• At least 1 year of medical billing experience.

• At least 1 year of I Microsoft Excel work experience including creating spreadsheets, editing and formatting, and using pivot tables

Preferred

• Associate’s or Bachelor’s degree

• Knowledge of medical billing specifically in behavioral, homecare, and long-term care insurance.

• Collections experience in a healthcare setting.

• Working knowledge of medical billing systems (i.e. Medic, IDX, Avatar, Tier, Medical Manager, etc.)

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

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All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

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