Apex Practice Management Group is seeking a highly experienced Medical Accounts Receivable, Collections, Appeals, and Payment Posting Specialist. This position requires an expert-level medical biller with a strong record of recovering outstanding balances from insurance companies and patients. The ideal candidate can independently manage complex accounts, identify the true cause of unpaid or underpaid claims, prepare strong appeals, correct billing errors, and aggressively follow up until payment or final resolution. Key ResponsibilitiesInsurance A/R and Collections Work insurance A/R accounts from initial follow-up through final resolution. Review aging reports and prioritize high-dollar, timely-filing, and near-deadline claims. Follow up with Medicare, Medicare Advantage, Medicaid/Medi-Cal, HMOs, PPOs, IPAs, workers' compensation plans, and commercial insurance carriers. Contact insurance companies through payer portals and telephone follow-up. Identify the exact reason claims remain unpaid, denied, rejected, suspended, or underpaid. Document claim status, reference numbers, representatives contacted, required actions, and follow-up dates. Escalate unresolved claims to supervisors, provider representatives, or payer management when necessary. Review contracts, fee schedules, EOBs, ERAs, and payment policies to identify underpayments. Request corrected payments, reconsiderations, reprocessing, or adjustment of incorrectly processed claims. Prevent claims from exceeding timely-filing and appeal deadlines. Review old A/R and recover balances that previous billing efforts did not resolve. Denials and Appeals Analyze denials and determine whether the claim requires correction, reconsideration, formal appeal, corrected claim submission, retroactive authorization, or medical-necessity documentation. Prepare complete, organized, and persuasive appeal packages. Draft payer-specific appeal letters supported by medical records, authorizations, referrals, operative reports, coding guidelines, claim history, proof of timely filing, and payer correspondence.

Handle appeals involving:

Timely-filing denials Authorization and referral denials Medical-necessity denials Bundling and coding denials Modifier-related denials Eligibility and coordination-of-benefits issues Duplicate-claim denials Noncovered-service denials Incorrect payment and underpayment Missing or invalid information Track every appeal through determination and pursue additional appeal levels when appropriate. Maintain accurate appeal deadlines, submission dates, confirmation numbers, and supporting documentation. Recognize appeal opportunities and avoid unnecessary write-offs. Payment Posting Accurately post insurance payments, patient payments, contractual adjustments, denials, recoupments, refunds, and take-backs. Post payments from ERAs, EOBs, checks, credit cards, electronic deposits, and lockbox reports. Reconcile posted payments with deposits and payer remittance reports. Review adjustment and denial codes before closing or transferring balances. Identify incorrect contractual adjustments, unapplied payments, payment variances, and credit balances. Ensure secondary claims are generated or submitted after primary insurance payments. Transfer balances to secondary insurance or patients only after verifying responsibility. Correct posting errors and maintain accurate patient and insurance balances. Report payment discrepancies, missing checks, recoupments, and unexplained deposits immediately. Patient Collections Review patient balances for accuracy before initiating collection activity. Confirm that insurance processing, adjustments, secondary billing, and patient responsibility are correct. Contact patients professionally regarding outstanding deductibles, coinsurance, copayments, and noncovered services. Explain statements and insurance responsibility clearly and respectfully. Establish authorized payment arrangements according to practice policy. Process payments and document all patient communications. Follow applicable federal and California collection, privacy, and consumer-protection requirements. Refer qualifying accounts for outside collections only after completing required internal procedures and receiving management approval. Reporting and Documentation Maintain detailed and accurate account notes in DrChrono. Provide daily and weekly reports showing: Accounts worked Claims resolved Payments recovered Appeals submitted Appeal outcomes Outstanding high-dollar claims Timely-filing risks Underpayments identified Patient collections Issues requiring management attention Track productivity and collection results by payer, provider, location, aging category, and denial reason. Identify recurring billing problems and recommend corrective action. Never adjust, close, or write off a balance without proper documentation and authorization. Required Qualifications Minimum of five years of recent, hands-on medical A/R, insurance collections, denial management, appeals, and payment-posting experience. Advanced experience working aged and difficult medical accounts. Demonstrated success recovering payments from insurance companies and patients. Strong understanding of Medicare, Medicare Advantage, Medi-Cal, HMOs, PPOs, IPAs, and commercial insurance plans. Expert knowledge of EOBs, ERAs, CPT codes, ICD-10 codes, modifiers, denial codes, payer policies, authorization requirements, and timely-filing rules. Ability to prepare complete first-level and higher-level appeal packages. Experience identifying and recovering payer underpayments. Strong understanding of primary, secondary, and tertiary insurance billing. Excellent written and verbal communication skills. Strong attention to detail, follow-through, organization, and accountability. Ability to work independently with minimal supervision. Ability to manage a large A/R inventory while meeting deadlines. Experience with DrChrono or a comparable medical practice-management system. Working knowledge of payer portals, clearinghouses, Excel, electronic remittance systems, and document-management tools. Must maintain HIPAA compliance and protect all patient and practice information. Preferred Qualifications Seven or more years of medical billing and collections experience. Experience with multispecialty practices, including ENT, head and neck surgery, colorectal surgery, general surgery, internal medicine, nephrology, allergy, audiology, and in-office procedures. Experience with California insurance plans, delegated medical groups, and IPAs. Certified Professional Biller, Certified Professional Coder, or another recognized billing or revenue-cycle credential. Experience training other billing and collection team members. Performance Expectations The selected candidate will be expected to: Consistently reduce outstanding A/R. Recover collectible balances without unnecessary write-offs. Meet all claim, corrected-claim, reconsideration, and appeal deadlines. Maintain accurate payment posting and account balances. Produce complete, timely, and well-supported appeals. Keep clear notes so every account's status and next action can be immediately understood. Communicate payer problems and financial risks to management promptly. Demonstrate measurable monthly collection and recovery results. Important Requirements This is not an entry-level medical billing position. Applicants must have substantial hands-on experience managing complex A/R, denials, appeals, payment posting, insurance collections, and patient collections. Applicants should be prepared to explain: The types of insurance plans they have worked with The average size and age of the A/R inventory they managed Examples of difficult denials or underpayments they successfully resolved Their process for timely-filing appeals Their experience with payment reconciliation Their monthly collection or recovery results

Pay:

$20.00 - $25.00 per hour Expected hours: 24.0 - 40.0 per week

Work Location:

In person