Accounts Receivable (A/R) Specialist in Wilmington, Delaware at Regional Medical Management Services LLC

Position Summary
RMMS is seeking a detail-oriented Accounts Receivable (A/R) Specialist to join our revenue cycle team. The A/R Specialist is responsible for following up on outstanding insurance and patient balances, resolving denied and rejected claims, filing timely appeals, and ensuring accurate, prompt collection of revenue owed to the practice. This role works closely with billers, coders, and front-office staff to identify root causes of delayed payment and recover revenue. Reports to the Medical Billing Supervisor.

Key Responsibilities
Insurance Follow-Up & Collections
• Work assigned A/R aging buckets daily; prioritize follow-up by dollar amount, payer, age, and timely-filing risk.
• Contact commercial, Medicare, Medicaid, and Workers' Comp payers via phone, payer portals, and EDI to research claim status and resolve unpaid claims.
• Document every account touch with clear, time-stamped notes capturing payer contact, reference numbers, next steps, and follow-up dates.
• Meet or exceed productivity standards and quality benchmarks set by leadership.

Denials, Appeals & Rejections
• Review denied and rejected claims; identify root cause (coding, eligibility, authorization, medical necessity, timely filing, coordination of benefits, duplicate, etc.).
• Correct and resubmit claims; draft and submit timely written appeals with supporting documentation per payer requirements.
• Track appeal status, escalate aged appeals, and pursue second-level appeals when warranted.
• Identify denial trends by payer, CPT, provider, or location; report patterns to the supervisor to drive upstream fixes.

Account Resolution & Adjustments
• Post payer adjustments, contractual allowances, and approved write-offs accurately within practice management system policies.
• Submit refund requests, recoupment responses, and credit-balance resolutions in coordination with the billing supervisor.

Reporting, Compliance & Collaboration
• Maintain accurate productivity logs; participate in weekly A/R review meetings and report on assigned Accounts.
• Comply with HIPAA, payer requirements, and internal policies; protect Protected

Health Information (PHI) at all times.
• Partner with coders, front-desk, and clinical staff to resolve documentation, coding, or registration issues that affect claim payment.
• Contribute to process improvement by identifying inefficiencies and suggesting workflow or system enhancements.