Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable Specialist is responsible for submitting accurate billing to appropriate payers and actively following up on claims to ensure timely adjudication and reimbursement. This role communicates directly with commercial, governmental, and other third-party payers, as well as patients, guarantors, family members, and internal medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring compliance with payer requirements and regulatory standards.

Key Responsibilities:

• Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges, subscriber data, diagnosis and procedure codes, late charges, and supporting documentation.
• Submits claims in a timely manner in accordance with payer contracts, federal and state regulations, departmental standards, and form requirements.
• Follows up directly with commercial, governmental, and other payers via phone, correspondence, and electronic systems to resolve unpaid, underpaid, denied, or rejected claims.
• Identifies specific reasons for denials, underpayments, and payment delays; takes appropriate corrective action to secure reimbursement.
• Prepares, drafts, and submits technical and clinical appeals as needed, ensuring accurate and complete documentation.
• Re-bills accounts when new or corrected demographic, insurance, or third-party information is received and updates patient records accordingly.
• Verifies insurance, payer, and patient demographic information for accuracy at registration and during account follow-up, entering verification data into billing systems as required.
• Reviews internal and external reports to monitor claim status, payment variances, denial trends, and outstanding accounts.
• Maintains thorough documentation of all account activity, including payer contacts, phone numbers, correspondence, and actions taken, within the host system and/or tracking tools.
• Maintains a working knowledge of payer-specific requirements, contracts, and applicable federal and state regulations, applying them appropriately to account resolution.
• Identifies trends and root causes of accounts receivable issues and communicates findings and recommendations to management.
• Demonstrates initiative, effective problem-solving and analytical skills with the ability to determine appropriate collection strategies to resolve accounts.
• Ability to meet productivity and quality standards.

Qualifications:

• One year previous experience in Revenue Cycle/Medical billing, follow up and collections or related degree/certification in Healthcare Management.
• Proficiency in basic computer applications, including Microsoft Excel.
• High School diploma or GED preferred.
• Strong verbal and written communication skills.
• Must be at least 18 years of age.

Physical Demands:

• Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

Work Environment:

• Climate controlled office setting with daily movement throughout the facility
• Interaction with department members and other healthcare providers
• Work schedule is remote, hybrid or in office.

Scheduled Weekly Hours: 40

Scheduled FTE: 1

Location: ThedaCare Corporate Office - Neenah, Wisconsin

Overtime Exempt: No

Worker Shift Details: Days