Accounts Receivable Specialist

Role : Accounts Receivable Specialist Location: Remote 100% Term: Contract Pay Rate: $23/hr W2

Position Summary: The Senior Process Executive – Accounts Receivable is responsible for managing and optimizing the full lifecycle of hospital and professional claims across third-party payers, including commercial insurance, Medicare, and Medicaid. This role requires advanced knowledge of US healthcare billing, claims adjudication, and payer-specific requirements, ensuring timely and accurate reimbursement for healthcare services. Qualifications Bachelor’s degree or equivalent experience required; preferred in Business, Healthcare Administration, or related field. Minimum 1–2 years of hands-on experience in US healthcare revenue cycle management, with a focus on hospital and professional claims. In-depth understanding of UB-04 and CMS-1500 claim forms, ICD-10, CPT/HCPCS coding, and payer guidelines. Key Responsibilities Manage accounts receivable processes for hospital and professional claims, ensuring compliance with US payer regulations. Analyze and resolve outstanding claims, including denials and underpayments, using payer-specific portals and resources. Investigate root causes of denials, apply appropriate ICD-10 and CPT codes, and implement corrective actions to maximize reimbursement. Prepare and submit appeals to insurance companies and Medicare, including redetermination requests and supporting documentation. Perform online submission of claims and monitor claim status through portals. Review aged receivables, recommend write-offs for uncollectible accounts, and report findings to the Account Manager. Maintain up-to-date knowledge of payer policies, federal and state regulations (HIPAA, CMS guidelines), and industry best practices. Collaborate with internal teams and external payers to resolve complex claim issues and expedite payment. Personal & Technical Skills Exceptional communication and interpersonal skills; able to interact professionally with payers, providers, and team members. Strong problem-solving and critical thinking abilities, with attention to detail and accuracy. Demonstrated ability to prioritize tasks, manage multiple deadlines, and adapt to changing regulatory requirements. High level of integrity, work ethic, and commitment to organizational goals. Proficiency in healthcare billing software, payer portals, and Microsoft Office Suite. Preferred Attributes Experience with US hospital billing systems (Epic, Cerner, Meditech, etc.). Familiarity with payer regulations, including appeals and redetermination processes. Ability to work independently and as part of a collaborative team.