Accounts Receivable (A/R) & Insurance Follow-Up Specialist

About AdvantixxRCM
AdvantixxRCM provides comprehensive revenue cycle management services to healthcare providers, including medical billing, insurance follow-up, denial management, payment posting, credentialing, and revenue optimization.

We are seeking an experienced Accounts Receivable (A/R) & Insurance Follow-Up Specialist who understands that submitting a claim is only the beginning—the ultimate objective is obtaining accurate and timely reimbursement for our clients.

Position Summary

The A/R & Insurance Follow-Up Specialist is responsible for managing outstanding insurance accounts and aggressively pursuing appropriate reimbursement from Medicare, Medicaid, Medicare Advantage, Medicaid Managed Care, and commercial insurance payers.

This individual will investigate unpaid, delayed, denied, rejected, and underpaid claims and take appropriate action until each assigned account reaches resolution.

We are looking for someone who can work an A/R aging report independently and take ownership of accounts from follow-up through resolution.

Essential Duties & Responsibilities

Insurance A/R Follow-Up

• Work assigned insurance A/R aging reports daily.
• Follow up on unpaid and outstanding insurance claims.
• Research claim status through payer portals, clearinghouses, telephone calls, and other available resources.
• Determine why claims remain unpaid.
• Contact insurance companies regarding delayed or incorrectly processed claims.
• Document every follow-up action accurately.
• Establish appropriate follow-up dates and continue working accounts until resolution.
• Prioritize high-dollar and aging accounts.
• Identify claims approaching timely-filing or appeal deadlines.
• Escalate significant reimbursement issues to management.

Denials & Rejections

• Investigate rejected and denied claims.
• Review CARC/RARC codes and payer explanations.
• Determine appropriate corrective action.
• Correct and resubmit claims when appropriate.
• Submit reconsiderations and appeals.
• Obtain supporting documentation when required.
• Track appeals through final determination.
• Identify recurring denial patterns and communicate them to management.
• Work with billing, coding, credentialing, eligibility, and authorization teams to resolve root causes.

Underpayment & Reimbursement Review

• Review EOBs and ERAs.
• Identify potential underpayments.
• Compare reimbursement against expected or contracted reimbursement when information is available.
• Research incorrectly processed claims.
• Request claim reprocessing when appropriate.
• Identify coordination-of-benefits issues.
• Research primary and secondary payer issues.
• Escalate suspected payer reimbursement problems.

A/R Management

• Work accounts across aging categories, including:

0–30 Days | 31–60 Days | 61–90 Days | 91–120 Days | 120+ Days

Special attention should be given to aging balances, high-dollar accounts, filing deadlines, and claims requiring immediate intervention.

Documentation

Every account worked must contain clear documentation describing:

• Date of follow-up
• Payer contacted
• Claim status
• Representative/reference information when applicable
• Reason payment remains outstanding
• Action taken
• Documentation requested or submitted
• Expected resolution
• Required next action
• Follow-up date

Required Qualifications

• Minimum 2 years of medical billing, insurance follow-up, or healthcare A/R experience preferred.
• Experience working insurance aging reports.
• Experience communicating directly with insurance companies.
• Knowledge of Medicare, Medicaid, Medicare Advantage, Medicaid Managed Care, and commercial insurance.
• Understanding of CMS-1500 professional claims.
• Experience with EOBs and ERAs.
• Knowledge of claim denials, rejections, reconsiderations, and appeals.
• Familiarity with CPT, HCPCS, ICD-10-CM, modifiers, and CARC/RARC codes.
• Experience using payer portals and clearinghouses.
• Strong research and problem-solving abilities.
• Excellent documentation skills.

Preferred Qualifications

• Previous experience with an RCM or medical billing company.
• Experience handling multiple healthcare practices or clients.
• CPC, CPB, CRCR, or related certification.
• Medicare and Medicaid billing experience.
• Experience with behavioral health, primary care, specialty medicine, or other outpatient services.
• Experience with Availity, Office Ally, Waystar, Change Healthcare/Optum, or similar systems.
• Bilingual English/Spanish is a plus.

Performance Expectations

Performance will be measured using appropriate departmental KPIs, including:

• Number and quality of accounts worked
• A/R resolution
• Reduction of aging balances
• A/R over 90 days
• Recovery of outstanding reimbursement
• Follow-up turnaround time
• Appeal/reconsideration completion
• Documentation quality
• Accuracy
• Timely-filing protection
• Compliance with company and client procedures

Quality and actual account resolution are more important than simply documenting a high number of touches.

Originally posted on Himalayas