Accounts Receivable Specialist in Dover, New Jersey at ZUFALL HEALTH CENTER INC

Reporting to the Revenue Cycle Manager, the Insurance Accounts Receivable (A/R) Specialist will support the organization’s revenue cycle operations. This role is responsible for the timely follow-up and resolution of outstanding insurance claims across Medicaid and commercial payers, ensuring accurate reimbursement and minimizing aged receivables.

The A/R Specialist will conduct detailed account analysis, address claim denials and underpayments, and collaborate with internal teams to identify and resolve barriers to payment. This position requires a strong understanding of payer guidelines, attention to detail, and the ability to manage a high-volume work queue while maintaining quality and compliance standards.

Essential Functions, Duties and Responsibilities

• Perform timely and thorough follow-up on assigned insurance A/R accounts (Medicaid and commercial)
• Analyze and resolve claim denials, rejections, and underpayments in accordance with payer policies and contractual requirements
• Initiate and track appeals, corrected claims, and reconsiderations through final resolution
• Utilize payer portals and direct payer communication channels to obtain claim status and facilitate resolution
• Identify trends and root causes impacting reimbursement and escalate systemic issues as appropriate
• Maintain accurate, detailed, and audit-ready documentation of all account activity
• Collaborate with front-end, coding, and billing teams to resolve upstream issues affecting claims adjudication
• Prioritize workload effectively to address aging accounts and high-dollar balances
• Consistently meet established productivity, quality, and timeliness benchmarks

Knowledge, Skills and Abilities

• Experience with eClinicalWorks (eCW)
• Prior experience in an FQHC or community health center setting
• Familiarity with payer denial trends and reimbursement regulations impacting healthcare organizations
• Timely and consistent resolution of assigned A/R inventory
• Reduction in aged receivables, particularly accounts over 90 days
• Demonstrated ability to independently move accounts toward resolution
• High-quality, compliant, and audit-ready documentation
• Consistent achievement of productivity and quality benchmarks
• Proven ability to independently manage a high-volume A/R inventory
• Strong analytical, organizational, and problem-solving skills
• Effective written and verbal communication skills, including payer interaction
• Proficiency with payer portals and revenue cycle systems

Education, Training and Experience

• Minimum of 2 years of experience in insurance A/R follow-up within a healthcare setting
• Demonstrated experience resolving denials and appeals through to completion, not solely performing status checks
• Working knowledge of:
• Medicaid (New Jersey experience preferred)
• Commercial payer reimbursement methodologies and denial processes