Schedule:

Monday-Friday | 40 Hours per Week |

Onsite Schedule Options:

8:00 AM-5:00 PM with a 1-hour lunch OR 8:00 AM-4:30 PM with a 30-minute lunch Position Overview We are seeking an experienced Customer Account Specialist to join a healthcare revenue cycle team. This position is responsible for analyzing, following up on, and resolving denied, underpaid, and unpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This individual will perform detailed account research, identify root causes affecting reimbursement, prepare appeals, work directly with insurance carriers, and collaborate with internal teams to resolve barriers to payment. This is an excellent opportunity for an experienced healthcare revenue cycle professional who is analytical, detail-oriented, and comfortable managing a high-volume workload. Key ResponsibilitiesDenials Management Review, analyze, and resolve denied claims across commercial, government, and managed care payers. Research denial reasons related to coding, authorization, eligibility, credentialing, registration, documentation, and payer processing. Prepare and submit first-level, second-level, and complex appeals within established payer deadlines. Gather and review medical records, referrals, authorizations, operative reports, and other documentation required for appeals. Monitor appeal status and follow claims through final resolution. Identify and escalate recurring payer trends and unresolved denial issues. Accounts Receivable Follow-Up Manage an assigned inventory of healthcare accounts receivable. Work accounts according to established productivity and aging standards. Perform comprehensive account research to identify barriers to reimbursement. Communicate with insurance carriers through payer portals, correspondence, and direct outreach. Pursue reimbursement for denied, partially paid, and unpaid claims. Research and resolve reimbursement discrepancies, payment variances, and payer processing errors. Maintain accurate and timely documentation of all follow-up activity. Reimbursement & Revenue Recovery Analyze Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer correspondence, and expected reimbursement . Investigate underpayments and payment variances. Review payer guidelines, policies, and contractual reimbursement expectations. Identify opportunities to recover reimbursement that might otherwise be written off. Recommend corrective actions to improve reimbursement outcomes and reduce future denials. Root Cause Analysis & Denial Prevention Identify recurring denial trends and reimbursement obstacles. Collaborate with Coding, Credentialing, Registration, Authorizations, Cash Posting, Credits, and Billing teams to resolve issues. Identify workflow, operational, or system issues contributing to denials. Participate in denial-prevention and revenue-cycle improvement initiatives. Help identify opportunities to improve clean claim rates and reduce AR aging. QualificationsRequired High School Diploma or equivalent. Strong understanding of healthcare reimbursement and insurance claims processing. Knowledge of denial management, appeals processes, and payer requirements. Working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical necessity requirements . Ability to interpret EOBs, ERAs, payer policies, and reimbursement guidelines. Strong analytical, research, and problem-solving abilities. Ability to identify root causes and independently work through complex account issues. Strong organizational skills and ability to manage a high-volume workload. Excellent written and verbal communication skills. Preferred Associate's or Bachelor's degree. Experience with physician practice billing and professional claims . Experience supporting a multi-specialty healthcare organization. Certified Revenue Cycle Representative ( CRCR ) certification or willingness to obtain. #

RSDHT Pay:

$20.00 - $28.00 per hour

Benefits:

401(k) matching Dental insurance Health insurance Vision insurance

Work Location:

In person