Accounts Receivable / Claims Follow-Up Specialist

We are a multi-site medical dermatology practice serving Northern California and Southern Oregon. This role focuses on working aging accounts, resolving stalled claims, and collecting reimbursement. Day-to-day claim submission is handled by an external billing vendor, so this position is not responsible for charge entry, coding, or first-pass claim submission.

The specialist will own follow-up on unpaid and underpaid insurance claims, especially balances over 60–120+ days, work payer portals and appeals, document everything in Nextech, and identify process failures that are affecting reimbursement.

Key responsibilities

• Work insurance aging reports daily, with priority on 90+ and 120+ day balances
• Investigate unpaid, denied, rejected, and underpaid claims
• Contact commercial payers, Medicare, Medicare supplements, Partnership HealthPlan, and Medi-Cal
• Use payer portals, EOBs/ERAs, and clearinghouse status in TriZetto to determine next steps
• Correct claim issues, request reprocessing, file appeals, and track claims through payment
• Document all follow-up activity in Nextech with clear notes and next-step dates
• Identify patterns related to timely filing, eligibility, authorization, modifiers, bundling, secondary billing, and coordination of benefits
• Report weekly on dollars worked, dollars collected, remaining aged AR, and root-cause trends
• Protect PHI and follow HIPAA requirements at all times

Role focus

• Insurance AR and denial follow-up are the core of the position
• Coding is not part of the job
• Primary claim creation/submission is not the main responsibility
• High-volume patient collections are not the primary focus