Senior Medical Accounts Receivable Specialist

The Senior Medical Accounts Receivable Specialist is responsible for managing complex insurance accounts receivable, reducing outstanding A/R, resolving claim denials, and maximizing reimbursement while ensuring compliance with payer and regulatory requirements. This role serves as a subject matter expert within the Revenue Cycle team, providing guidance to team members, identifying workflow improvements, and collaborating with internal departments to resolve reimbursement issues efficiently.

Duties & Responsibilities:

• Manage a portfolio of high-value and aged insurance accounts receivable.
• Investigate and resolve denied, underpaid, and delayed claims across commercial, Medicare, Medicaid, Workers' Compensation, No-Fault/MVA, and other payers.
• Prepare and submit first- and second-level appeals with supporting clinical documentation.
• Analyze payer trends and identify root causes of denials.
• Work closely with coding, authorization, front desk, providers, and billing staff to resolve claim issues.
• Review payer contracts to identify reimbursement discrepancies.
• Follow up on outstanding claims through payer portals and direct communication with insurance representatives.
• Monitor timely filing deadlines and appeal timeframes.
• Document all account activity accurately within the practice management system.
• Recommend workflow improvements to reduce denials and improve reimbursement.
• Assist with training and mentoring new Accounts Receivable Specialists.
• Escalate complex reimbursement issues to leadership when appropriate.
• Maintain productivity and quality standards established by the department.
• Participate in special projects and revenue cycle initiatives as assigned.
• Manage and follow up on medical lien cases, including communicating with attorneys, insurance carriers, and third-party administrators to facilitate timely reimbursement

Education & Training:

• High school diploma or equivalent.
• Minimum of 5 years of medical accounts receivable experience.
• Minimum of 3 years of experience handling complex insurance follow-up and appeals.

Knowledge & Experience:

• Strong knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and payer guidelines.
• Experience with commercial insurance, Medicare, Medicaid, Workers' Compensation, and No-Fault claims.
• Proficiency using electronic medical records (EMR) and practice management systems.
• Advanced knowledge of payer portals and claim status tools.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to prioritize multiple deadlines in a fast-paced environment.
• CPC, CPB, or other AAPC certification preferred
• Orthopedic or surgical specialty experience preferred 
• Experience with Athenahealth or similar practice management systems preferred 
• Experience with denial analytics and revenue cycle reporting preferred

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 25 pounds at times.

Schedule: Monday-Friday, 40 hours per week
Pay: $28 - $32 per hour

Benefits Include:

• Six Company Paid Holidays
• Fourteen days Paid Time Off
• Medical, Dental & Vision
• Health Savings Accounts, Flexible Spending Accounts
• Parking & Transit Spending Accounts
• Life Insurance, Short Term Disability, Long Term Disability
• Family Leave Plan
• Legal Benefits
• Pet Benefits 
• 401k Retirement Plan with a generous 4% Employer Match
• Employee Assistance Program
• Flexible Working Hours

Health Plus Management LLC (HPM) provides management services to medical practices specializing in the area of Pain Management, PMN&R, and Orthopedics. HPM manages 45 locations throughout Long Island, NYC, including the 5 boroughs, Westchester, NJ, CT and Upstate. We provide management services that give the physicians and therapists the opportunity to provide patient care without worrying about the administrative needs of the practice.