Accounts Receivable Specialist in at Summit 360 Solutions

Account Receivables Specialist — Operations · Philippines – Remote

Summit360 Solutions is seeking an experienced Account Receivables Specialist to join our Operations team in Philippines – Remote. You'll play a pivotal role in delivering high-quality outcomes for our clients, working alongside a collaborative team that values precision, safety, and craft.

Position Summary

The Accounts Receivable (AR) Specialist is responsible for the timely follow-up, tracking, and resolution of unpaid and underpaid insurance claims across Medsense Health's four provider entities. This role works closely with the Revenue Cycle Manager to reduce days in AR, resolve denials, and ensure clean, timely reimbursement from Medicare, Medicaid, and commercial payers.

Key Responsibilities
• Perform daily follow-up on outstanding insurance claims across all four Medsense Health entities via payer portals (Availity, NGSConnex, Novitasphere, Palmetto GBA eServices, WPS SNAP, Payspan, ECHO Health, Blue e, UHC, and others) and payer phone lines.
• Prioritize and work claims assigned in their queue based on claim age, dollar value, and payer timely-filing deadlines, ensuring all assigned claims are addressed within expected turnaround times.
• Monitor aging AR reports and prioritize follow-up based on claim age, dollar value, and payer timely-filing deadlines.
• Investigate and resolve claim denials and rejections, identifying root cause (e.g., coding errors, POS errors, COB issues, missing authorizations, eligibility issues) and routing corrections to the appropriate team member.
• Document all follow-up activity, payer communications, and next steps in the billing/claims system using a consistent format (action taken, outcome, next step).
• Escalate claims requiring medical records, appeals, or additional documentation, and track submission deadlines (e.g., prepayment review requests, appeal windows).
• Identify and flag recurring denial trends or payer-specific issues to the Revenue Cycle Manager for process correction.
• Support coordination of benefits (COB) follow-up, secondary claim submission, and resolution of primary/secondary payer mismatches.
• Maintain strict compliance with HIPAA and PHI handling requirements in all payer and internal communications.
• Assist with special projects as needed, such as large-scale claim corrections, payer audits, or EFT/ERA enrollment follow-up.

Qualifications
• 2+ years of experience in healthcare accounts receivable, medical billing, or claims follow-up, ideally across multiple provider entities or a multi-payer environment.
• Working knowledge of Medicare Part B, Medicaid, and commercial payer claim requirements.
• Familiarity with common payer portals and clearinghouses (e.g., Availity, NGSConnex, Novitasphere, Payspan, ECHO Health) strongly preferred.
• Understanding of CPT, ICD-10, and POS coding as it relates to claim denials and corrections.
• Strong written communication skills for professional payer correspondence.
• Highly organized, detail-oriented, and comfortable managing a high volume of concurrent claims across multiple entities.
• Ability to work US business hours.

Preferred Experience
• Experience with telehealth, RPM/RTM billing, or preventive medicine billing models.
• Experience with denial management, prepayment reviews, or payer audits.
• Experience supporting credentialing or payer enrollment processes a plus.

Reports To
Revenue Cycle Manager