Accounts Receivable Specialist

Reporting to the Revenue Cycle Manager, the Insurance Accounts Receivable (A/R) Specialist will support the organization’s revenue cycle operations. This role is responsible for the timely follow-up and resolution of outstanding insurance claims across Medicaid and commercial payers, ensuring accurate reimbursement and minimizing aged receivables.

The A/R Specialist will conduct detailed account analysis, address claim denials and underpayments, and collaborate with internal teams to identify and resolve barriers to payment. This position requires a strong understanding of payer guidelines, attention to detail, and the ability to manage a high-volume work queue while maintaining quality and compliance standards.

Essential Functions, Duties and Responsibilities

• Perform timely and thorough follow-up on assigned insurance A/R accounts (Medicaid and commercial) 
• Analyze and resolve claim denials, rejections, and underpayments in accordance with payer policies and contractual requirements 
• Initiate and track appeals, corrected claims, and reconsiderations through final resolution 
• Utilize payer portals and direct payer communication channels to obtain claim status and facilitate resolution 
• Identify trends and root causes impacting reimbursement and escalate systemic issues as appropriate 
• Maintain accurate, detailed, and audit-ready documentation of all account activity 
• Collaborate with front-end, coding, and billing teams to resolve upstream issues affecting claims adjudication 
• Prioritize workload effectively to address aging accounts and high-dollar balances 
• Consistently meet established productivity, quality, and timeliness benchmarks

Knowledge, Skills and Abilities

• Experience with eClinicalWorks (eCW) 
• Prior experience in an FQHC or community health center setting 
• Familiarity with payer denial trends and reimbursement regulations impacting healthcare organizations
• Timely and consistent resolution of assigned A/R inventory 
• Reduction in aged receivables, particularly accounts over 90 days 
• Demonstrated ability to independently move accounts toward resolution 
• High-quality, compliant, and audit-ready documentation 
• Consistent achievement of productivity and quality benchmarks
• Proven ability to independently manage a high-volume A/R inventory
• Strong analytical, organizational, and problem-solving skills
• Effective written and verbal communication skills, including payer interaction
• Proficiency with payer portals and revenue cycle systems

Education, Training and Experience

• Minimum of 2 years of experience in insurance A/R follow-up within a healthcare setting 
• Demonstrated experience resolving denials and appeals through to completion, not solely performing status checks 
• Working knowledge of: 
• Medicaid (New Jersey experience preferred) 
• Commercial payer reimbursement methodologies and denial processes