NextCare is looking for an Accounts Receivable Specialist to maintain the organization's financial health by ensuring the timely and accurate resolution of outstanding medical claims. You'll play a key role in reducing accounts receivable aging through proactive follow-up and expert denial management.
What You'll Do
- Verify patient insurance eligibility and benefits prior to claim submission.
- Review and analyze clearinghouse rejections to identify root causes.
- Monitor and follow up on unpaid and denied medical claims across a variety of payers including Commercial, Medicare, Medicaid, and Workers Comp Carriers.
- Research, analyze, and resolve claim denials and underpayments by identifying root causes, correcting errors, and submitting appeals.
- Reconcile accounts receivable by posting adjustments and resolving discrepancies.
- Generate and analyze A/R reports to identify patterns in denials or reimbursement delays and recommend process improvements.
- Partner with billing, coding, and compliance teams to ensure claims are processed accurately.
- Maintain strict adherence to HIPAA regulations, payer-specific guidelines, and company policies.
- Treat patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
- Perform other related duties as assigned.
What We're Looking For
- Minimum of High School diploma or equivalent.
- Minimum of 5 years of experience in medical billing or accounts receivable with a strong emphasis on insurance claim resolution and denial management.
- In-depth understanding of medical billing and coding principles (CPT, ICD-10, HCPCS) and payer reimbursement methodologies.
- Proficiency with medical billing software; Waystar Clearinghouse expertise is required.
- Strong ability to interpret EOBs, remittance advice, and payer correspondence to resolve complex claim issues.
- Exceptional accuracy in data entry, financial reconciliation, and documentation.
- Effective written and verbal communication skills for professional interaction with payers, internal teams, and external stakeholders.
Nice to Have
- Experience with NextGen Billing is strongly preferred.
Technical Stack
- Medical billing software
- NextGen Billing
- Waystar Clearinghouse
Work Mode
This position is onsite.
