Medical Billing Accounts Receivable (A/R) Follow -Up Specialist in Worcester, Massachusetts at Mass Lung & Allergy PC

Medical Billing Accounts Receivable (A/R)
Follow-Up Specialist Job Description
Position Summary
The Medical Billing Accounts Receivable (A/R) Follow-Up Specialist is responsible for managing
and resolving outstanding insurance and patient accounts to ensure timely reimbursement for
healthcare services. This role involves reviewing unpaid claims, researching denials,
communicating with insurance companies and patients, and working collaboratively with billing and
clinical staff to maximize revenue recovery and reduce accounts receivable aging.
Key Responsibilities
- Review and monitor outstanding insurance and patient account balances.
- Follow up with insurance carriers on unpaid, denied, or underpaid claims.
- Investigate claim rejections and denials and take corrective actions for resubmission.
- Identify trends in claim denials and recommend process improvements.
- Contact payers to verify claim status, payment information, and authorization requirements.
- Appeal denied claims and submit supporting documentation when necessary.
- Document all follow-up activities accurately in the billing system.
- Work aging reports to prioritize and resolve outstanding balances.
- Collaborate with coding, billing, and clinical departments to resolve claim issues.
- Verify insurance coverage, eligibility, and benefits as needed.
- Reconcile payment discrepancies and identify payer reimbursement issues.
- Ensure compliance with HIPAA, payer regulations, and company policies.
- Meet productivity and collection goals established by management.
Qualifications
Education: High school diploma or GED required. Associate degree in Healthcare Administration,
Medical Billing and Coding, or related field preferred.
Experience: 1-3 years of medical billing or healthcare accounts receivable experience preferred.
Experience with commercial insurance, Medicare, Medicaid, and managed care plans. Knowledge
of denial management and appeals processes.
Required Skills
- Strong understanding of medical billing and revenue cycle management.
- Knowledge of CPT, ICD-10, and HCPCS coding concepts.
- Familiarity with EHR and billing software.
- Excellent verbal and written communication skills.
- Strong analytical and problem-solving abilities.
- Attention to detail and organizational skills.
- Ability to manage multiple accounts and meet deadlines.
- Proficiency with Microsoft Office, especially Excel.
Key Performance Indicators (KPIs)
- Reduction in A/R aging over 60, 90, and 120 days.
- Insurance claim resolution rate.
- Denial overturn and appeal success rate.
- Collection and reimbursement recovery metrics.
- Productivity standards for account follow-up activities.
Reporting Structure
Reports To: Billing Manager / Revenue Cycle Manager
Department: Revenue Cycle Management / Medical Billing
Status: Full Time