Job Description

You’re more valuable than ever – And that’s just how we’ll make you feel.

Job Title: Accounts Receivable Specialist

Department Revenue Cycle

Reports To: Manager, Market Revenue Cycle

Receives Direction From: Manager and Senior Manager, Market Revenue Cycle

Direct Reports: None

Entity: Access Clinical Partners, LLC dba GoHealth Urgent Care

FLSA Status: Non-exempt

Work Location: Remote

Job Code: 910009

The Accounts Receivable Specialist is responsible for follow up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients, patients and fellow staff.

Qualifications

Education Required:

• High school diploma or GED

Work Experience Required:

• 3+ years healthcare billing accounts receivable experience in a mid-to-large organization

Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.:

• 3+ years of Healthcare AR experience with large complex physician practice groups
• EMR experience across a minimum of one platform (i.e., Epic or Clinical Works)
• CPAR – Certified Patient Account Representative
• Certified Medical Billing Specialist
• Associate’s degree in Healthcare Management, Health information Management or related field

Knowledge, Skills, and Abilities

Technical Knowledge

• Working knowledge of CPT and ICD coding
• Knowledge of basic medical terminology
• Understanding of insurance guidelines, including Medicare, state Medicaid, and workers’ compensation across multiple states
• Ability to interpret and understand Explanation of Benefits (EOBs)
• Ability to accurately calculate deductibles and coinsurance

Communication & Interpersonal Skills

• This role involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.
• Ability to maintain strict patient confidentiality
• Excellent verbal and written communication skills
• Strong phone etiquette and customer service skills
• Ability to communicate effectively with patients regarding medical conditions and financial responsibilities
• Ability to represent the department professionally when interacting with patients, guests, physicians, and staff
• Ability to handle service issues tactfully and professionally and ensure appropriate follow-through

Organizational & Administrative Skills

• Proficiency in Microsoft Office applications, including Excel and Word
• Strong organizational and time management skills with the ability to prioritize effectively
• Proficiency in computer systems and typing
• Strong attention to detail, including mathematical accuracy

Teamwork & Collaboration

• Ability to work collaboratively across departments and function as an extension of urgent care centers
• Demonstrates flexibility and openness to new ideas and approaches
• Ability to remain focused and productive under pressure
• Proactively shares relevant information with team members
• Willingly assists others as needed
• Contributes to identifying and resolving enterprise-wide challenges

Essential Duties and Responsibilities

• Maintain accurate account and billing data by entering and updating patient demographic, guarantor, and insurance information; posting procedures and payments; and reconciling daily deposits.
• Manage accounts receivable through full lifecycle resolution, including:
  • Submitting claims via clearinghouses or directly to payers
  • Monitoring, researching, and resolving claim denials
  • Contacting insurance carriers to address payment issues
  • Filing appeals with appropriate documentation
  • Processing claim retractions, write-offs, and contractual adjustments in accordance with payer guidelines
• Ensure claim accuracy and compliance by entering complete and correct billing information, including patient details, insurance data, diagnosis and procedure codes, modifiers, and provider information.
• Review and post payments by:
  • Verifying insurance payments for accuracy and contract compliance
  • Posting insurance and patient payments within billing systems
  • Coordinating secondary billing for patients with multiple insurers
• Provide customer support and issue resolution by responding to inquiries from patients, providers, and insurance companies and assisting with inbound calls as needed.
• Verify insurance eligibility and benefits coverage to support accurate billing and reimbursement.
• Collaborate and communicate effectively with Team Leaders, Section Leaders, and cross-functional teams to provide updates, escalate issues, and support workflow efficiency.
• Deliver excellent customer service in all interactions with internal and external stakeholders.
• Ensure compliance and confidentiality by adhering to HIPAA regulations and safeguarding patient information.

GoHealth Core Values

GoHealth’s Core Values, listed below, are essential functions of this position:

• Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront.
• Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency through process and other forms of innovation.
• Diversity & Inclusion: Fosters diversity and inclusion, to be able to better understand team members, our customers and partners. Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed.
• Courage & Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect.
• Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities.

Additional Requirements

• Office Environment: Tasks may be conducted within a climate-controlled office setting.
• Physical Activity: The role may require the ability to lift, carry, push, or pull materials, supplies, and equipment (up to 10 lbs.) Duties typically involve a combination of sitting, standing, and walking, with frequent changes in position.
• Travel: Travel may be required, including travel between Company locations and out-of-town destinations as needed.
• Safety Equipment: May require the use of safety equipment for infection prevention.

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Note: This Job Description is not inclusive of all the duties of the position. You may be asked by Leaders to perform other duties. Leadership may revise this job description at any time.

Equal Employment Opportunity Statement

The Company and its affiliates, joint venture partners and entities under common management are Equal Opportunity Employers. They do not discriminate based on race, color, religion, national origin, age, sex, disability, veteran status, sexual orientation, gender identity, or any other protected status under federal, state, or local law.

ADA Accommodation Statement

Reasonable accommodations are available for qualified individuals with disabilities upon request. This role defines success by achieving essential function outcomes, not by the method of completion.

Compliance Statement

This job will be performed consistent with ADA, FMLA, FLSA, and other applicable federal, state, and local laws regulating employment.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

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