Medical Accounts Receivable Specialist

Bay Area Retina Associates is a group of experienced ophthalmologists specializing in advanced retinal treatments, with 10 Bay Area locations and over 40 years in the industry.

The Medical Accounts Receivable Specialist is responsible for resolving insurance accounts receivable by identifying root causes, correcting billing discrepancies, and ensuring compliance with payer requirements and reimbursement standards. The role supports revenue cycle performance through claims follow-up, payer communication, appeals, and reporting.

• Follow up on patient accounts to maximize reimbursement and work assigned claim and AR worklists.
• Resolve insurance-related issues including credit balances and payment discrepancies.
• Contact payers regarding appeals, reconsiderations, adjustments, claim corrections, and documentation requests.
• Monitor and resolve clearinghouse rejections.
• Bill secondary claims according to payer requirements.
• Escalate unresolved payer issues through grievance protocols.
• Collaborate with RCM team members and leadership to address billing, documentation, and reimbursement issues.
• Track payer trends and systemic billing issues.
• Maintain knowledge of payer contracts, timely filing rules, contract rates, and reimbursement terms.
• Stay current on healthcare regulations, state rules, and insurance plan requirements.
• Handle insurance correspondence professionally and meet productivity and KPI standards.
• Other duties as assigned.