[Hiring] RCM Accounts Receivable Specialist @Netsmart

Role Description

This role involves managing the accounts receivable process, including claim resolution and communication with payers.

• Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals.
• Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution.
• Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers.
• Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable.

• Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions.
• Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines.
• Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements.
• Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers.

• Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues.
• Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts.
• Build strong relationships with payer representatives to improve overall reimbursement efficiency.

• Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines.
• Review and resolve EDI rejections, claim edits, and submission errors.
• Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity.
• Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.

Qualifications

• High school diploma or GED.
• Minimum 1 year of medical billing, claims, or A/R experience.
• Advanced Microsoft Excel skills (vlookups, pivot tables, data organization).
• Strong analytical, investigative, and problem-solving skills.
• Excellent verbal and written communication skills.
• Demonstrated ability to work independently, meet deadlines, and achieve productivity goals.
• Basic understanding of insurance plans, medical terminology, Medicare and Medicaid billing guidelines.

Preferred Qualifications

• Experience in behavioral health, home care, long-term care, or similar clinical billing environments.
• Prior healthcare collections or reimbursement experience.
• Experience with medical billing platforms such as Medic, IDX, Avatar, Tier, Medical Manager, or similar systems.
• Exposure to or interest in automation, AI-supported workstreams, or RPA technologies used in revenue cycle operations.

Work Environment & Expectations

• Comfortable working in a remote environment using virtual communication and collaboration tools.
• Ability to perform job functions involving extended periods of computer and phone use.
• Commitment to accuracy, efficiency, and continuous improvement in revenue cycle operations.