[Hiring] Accounts Receivable Specialist @Capitol Imaging Services

Role Description

The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.

Key Responsibilities

• Claims & Vendor Management
  • Partner with external billing vendors to address claim rejections and payer requests for clarification.
  • Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions.
  • Review escalated accounts requiring internal oversight or final resolution.
• Denial Management & Appeals
  • Collaborate with vendor partners to identify denial trends, recurring payer issues, and root causes.
  • Provide feedback and strategic direction on appeal approaches and payment resolution tactics.
  • Authorize final adjustments after all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance.
  • Recommend process improvements to reduce future denials.
• Accounts Receivable Follow-Up
  • Proactively work A/R aging reports (30, 60, 90+ days) to identify unpaid or underpaid claims.
  • Initiate payer tracers and follow-ups to secure claim adjudication and payment.
  • Monitor high-risk and high-dollar accounts to prevent revenue leakage.
• Payment Posting & Reconciliations
  • Ensure accurate posting and reconciliation of insurance and patient payments.
  • Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy.
  • Assist with account reconciliations and discrepancies resolution as needed.
• Patient & Insurance Communication
  • Act as a liaison between patients and insurance payers to resolve billing questions.
  • Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.
  • Conduct professional and empathetic phone communication with patients and payer representatives.

Qualifications

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred
• 1–3 years of experience in:
  • Medical billing and collections
  • Accounts Receivable or Revenue Cycle Management
  • Healthcare payer follow-up and denial resolution
• Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)
• Strong working knowledge of Microsoft Office, particularly:
  • Excel (reports, aging analysis)
  • SharePoint
• Working knowledge of:
  • Medical terminology
  • CPT and ICD-10 coding
  • Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans
• Strong analytical and problem-solving skills
• Exceptional attention to detail and accuracy
• Effective written and verbal communication skills
• Ability to work collaboratively with internal teams and external vendor partners
• Sound judgment related to financial adjustments and account resolution