Job Description

Job Type

Full-time

Description

POSITION SUMMARY:

The Accounts Receivable Insurance Specialist handles insurance follow-up and account resolution for assigned payors to ensure timely reimbursement. Responsibilities include resolving billing issues, researching discrepancies, and addressing patient inquiries with a focus on service and communication. This role requires expertise in the revenue cycle, medical billing, and oncology-specific reimbursement guidelines.

CORE ESSENTIAL RESPONSIBILITIES:

• Manage accounts receivable for assigned payors by analyzing and resolving denials, appealing rejected claims, and correcting billing discrepancies to ensure timely reimbursement.
• Conduct consistent follow-up with insurance companies and address overdue claims across commercial and government payors.
• Review EOBs to confirm accurate payments and report discrepancies or trends to leadership.
• Maintain detailed documentation of collection efforts and resolution activities in EPIC using standard note format.
• Handle patient billing inquiries, negotiate payment plans, and respond promptly to calls or correspondence.
• Monitor and report credit balances; initiate appropriate refunds and write-offs with supporting documentation.
• Collaborate with internal teams to communicate billing issues, share updates, and support resolution.
• Verify patient insurance eligibility and benefits; understand payer-specific processes, including copays, deductibles, and coinsurance.
• Stay current on oncology coding standards (HCPCS/ICD-10/CPT) and participate in training and compliance initiatives.
• Support other revenue cycle functions as needed and perform additional duties as assigned.

Requirements

EDUCATION & EXPERIENCE

• High school diploma or equivalent required; associate degree in health sciences preferred.
• Minimum 3–5 years of experience in medical accounts receivable, with oncology/hematology billing preferred.
• At least 5 years’ experience in private practice accounts receivable.

KNOWLEDGE, SKILLS OR ABILITIES

• Proficient in medical billing and insurance reimbursement processes, including denial resolution and payer-specific guidelines.
• Thorough understanding of ICD-10, CPT required and working knowledge of HCPCS and modifiers specific to hematology/oncology treatments preferred.
• Proficient in using Epic or similar programs.