Job Description

Description

The Accounts Receivable Specialist is responsible for managing HighFive’s Oral Surgery insurance accounts receivable process. This role involves the timely and accurate submission of claims, following up on unpaid and denied claims, and working with insurance companies. We are looking for specific Oral Surgery billing experience specifically with TMJ (temporomandibular joint/orthognathic surgery) The accounts receivable representative will also work closely with healthcare payors or patients to resolve any billing discrepancies or issues. The goal is to exceed HighFive’s net collection rates and reduction of aging receivable as established by the RCM management team.

Responsibilities

• Investigate, appeal, and resolve denied or rejected claims by insurance payors. Work with insurance companies to clarify discrepancies and ensure proper reimbursement.
• Review and assess Explanation of Benefits (EOBs) at the claim level to determine issues.
• Determine root cause of any billing related or claim submission issues to prevent recurrence.
• Make corrections to claims based on denials and rebill utilizing standardized process and procedures.
• Follow up with unresolved claims through system resources, clearinghouse, payer portal or call to the payor, when necessary.
• Assess whether an appeal is required for a claim denial. Track appeals to ensure timely payment and resolution.
• Spot recurring patterns in denials and report them to management for further analysis and action.
• Effectively communicate both verbally and in writing with team members, payors, patients, and other relevant parties.
• Keep up to date with internal processes, industry standards, and government regulations relevant to denial management to ensure compliance and best practices.
• Participate in or take on special projects or additional duties as required by the team or management.
• Meet or exceed required accounts per day to meet HighFive and provider’s expectations.
• Achieve department goals for net collection rates and the resolution of denied claims, including those successfully paid or overturned.

Requirements

• Oral Surgery billing experience required.
• Denial/Claim OR AR Experience with TMJ (temporomandibular joint/orthognathic surgery)
• High school diploma or equivalent; associate or bachelor’s degree in healthcare, business, or a related field preferred.
• Minimum of 2 years of experience in healthcare billing and accounts receivable.
• Knowledge of medical insurance plans, billing procedures, and healthcare reimbursement processes.
• Proficiency with Electronic Health Record (EHR) systems and billing software.
• Dental billing experience preferred but not required.
• Working knowledge of excel and system workflows.
• Prior experience with mid or large-scale healthcare business office of 100 or more providers preferred.
• Strong attention to detail with the ability to accurately review and process claims.
• Excellent communication and problem-solving skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Knowledge of HIPAA and other healthcare compliance regulations.