[Hiring] Billing / Accounts Receivable Specialist @Infinit-O

Role Description

The Billing / Accounts Receivable Specialist is responsible for managing assigned accounts throughout the revenue cycle to support accurate claim submission, timely reimbursement, and resolution of outstanding balances. This role requires proactive follow-up with insurance payers, identification and correction of billing issues, denial resolution, payment review, and clear documentation of all account activity.

The ideal candidate is detail-oriented, accountable, productive, and able to independently investigate unpaid or underpaid claims while knowing when to escalate issues or request support.

Essential Duties and Responsibilities

• Review assigned accounts receivable work queues, aging reports, and outstanding claims.
• Follow up with insurance payers through payer portals, phone calls, electronic inquiries, and written correspondence.
• Investigate unpaid, underpaid, rejected, and denied claims to determine the appropriate resolution.
• Correct billing errors and submit corrected claims, reconsiderations, and appeals within payer filing deadlines.
• Review remittance advice, explanation of benefits, and electronic remittance data to verify proper claim processing.
• Identify payment discrepancies, contractual underpayments, inappropriate denials, and incorrect patient responsibility.
• Confirm claim receipt, processing status, payment information, denial reasons, and additional documentation requirements.
• Research eligibility, benefits, authorizations, referrals, coordination of benefits, credentialing, enrollment, coding, and claim-routing issues.
• Verify that claims include accurate patient, provider, payer, diagnosis, procedure, modifier, place-of-service, and billing information.
• Submit requested medical records and supporting documentation to payers.
• Transfer balances to the appropriate payer or patient only after completing necessary research.
• Work credit balances and payment-posting discrepancies as assigned.
• Maintain detailed account notes documenting actions taken, information received, reference numbers, representatives contacted, and required follow-up.
• Monitor deadlines for corrected claims, appeals, reconsiderations, and timely filing.
• Follow up consistently until each assigned claim or balance is fully resolved.
• Escalate recurring payer issues, system problems, credentialing concerns, coding questions, and high-dollar accounts.
• Communicate professionally with clients, providers, patients, payers, and internal team members.
• Meet established productivity, quality, accuracy, and turnaround-time expectations.
• Participate in account reviews, team meetings, training sessions, and process-improvement initiatives.
• Maintain confidentiality and comply with HIPAA, company policies, payer requirements, and applicable healthcare regulations.
• Perform additional billing and revenue-cycle duties as assigned.

Qualifications

• Education & Experience: High school diploma or equivalent. At least two years of medical billing, insurance follow-up, or healthcare accounts receivable experience required/preferred.
• Specialty Background: Strong background in billing for general outpatient specialties, primarily including Primary Care, Psychiatry, Gastroenterology, Dermatology, etc.
• EHR & System Expertise: Experience using practice management systems, electronic health records (EHRs), clearinghouses, and payer portals. Must have experience with platforms such as Tebra, SimplePractice, Practice Fusion, Athena, eClinicalWorks, etc.
• Work Ethic & Ownership: Highly self-driven candidates who take true ownership in their work, embrace a team environment, work independently, and do not require constant direction or monitoring.
• Core Skills:
  • Working knowledge of the medical billing and revenue-cycle process.
  • Experience researching claim status and resolving rejections, denials, and underpayments.
  • Ability to interpret remittance advice, explanation of benefits (EOB), denial codes, adjustment reason codes, and payer correspondence.
  • Familiarity with CPT, HCPCS, ICD-10-CM codes, modifiers, and medical terminology.
  • Strong written and verbal communication skills.
  • Strong organizational, problem-solving, and analytical skills.
  • Ability to manage multiple priorities and follow accounts through final resolution.
  • Proficiency with Microsoft Office, including Excel, Outlook, and Word.
• Probationary Period: Must successfully pass a 90-day probation period showcasing productivity, self-direction, and ownership.

Requirements

• Experience working with Medicare, Medicaid, commercial insurance, managed-care plans, and workers’ compensation.
• Experience preparing corrected claims, reconsiderations, and formal payer appeals.
• Knowledge of payer contracts, reimbursement methodologies, and contractual adjustments.
• Certified Professional Biller (CPB), Certified Professional Coder (CPC), or another relevant healthcare certification.
• Experience working in a multi-specialty or outsourced revenue-cycle environment.

Performance Expectations

• Consistently meet established productivity and quality standards.
• Maintain accurate, complete, and timely account documentation.
• Prioritize high-dollar, aging, and timely-filing-sensitive claims.
• Demonstrate ownership of assigned accounts and follow through until resolution.
• Avoid unnecessary claim resubmissions, duplicate claims, and preventable clearinghouse or payer fees.
• Identify trends rather than repeatedly working individual accounts without addressing the underlying issue.
• Communicate barriers and request assistance before an issue affects reimbursement or client service.
• Complete assigned work within required timeframes.
• Maintain professional and responsive communication with clients and team members.