Medical Billing Specialist - AR Focused

Job Summary

Responsible for managing all aspects of the medical billing and collections process for a multi-location urgent care organization. Ensures timely and accurate claim submission, effective management of accounts receivable, and resolution of billing issues including denials, rejections, and modifier/coding issues to maximize reimbursement and maintain compliance with payer regulations.

Works under the direction of the RCM manager and collaborates with providers, front office staff, clinical teams, and management to identify and resolve claim issues, improve charge capture, and support the efficient flow of revenue throughout the billing cycle.

Essential Duties

• Review, prepare, and submit electronic and paper claims accurately and on time, typically within 24 hours of patient discharge.
• Verify claim completeness, coding accuracy, and supporting documentation before submission.
• Monitor claim acceptance, rejections, and edits through clearinghouse and payer systems.
• Correct and resubmit rejected or denied claims promptly.
• Manage assigned accounts receivable to ensure timely reimbursement and achievement of A/R goals.
• Analyze aging reports and prioritize accounts by payer, balance, aging category, and reimbursement impact.
• Follow up on outstanding claims through payer portals, telephone inquiries, and written correspondence.
• Investigate and resolve underpayments, payment variances, denials, and non-payment issues.
• Track timely filing limits and take appropriate action to prevent avoidable write-offs.
• Maintain designated A/R work queues and productivity standards.
• Escalate complex payer disputes, contract discrepancies, and unresolved reimbursement issues to management.
• Identify trends contributing to increased A/R, denial rates, or delayed payments and recommend corrective actions.
• Collaborate with front office, back office, coding, and provider teams to address root causes of billing issues.
• Assist in developing workflows and process improvements to reduce days in A/R and increase collection efficiency.
• Pursue appropriate reimbursement opportunities while maintaining compliance with payer contracts, regulations, and organizational policies.
• Monitor patient balances and coordinate with applicable departments to facilitate resolution.
• Maintain accurate documentation of collection activity, payer communications, appeals, and account actions in the practice management system.
• Support month-end and year-end revenue cycle initiatives focused on aged receivables and high-priority collection opportunities.
• Analyze denial reasons and prepare appeals with supporting documentation.
• Track appeal outcomes and identify opportunities to reduce recurring denials.
• Partner with front office teams to resolve registration, eligibility, authorization, and demographic issues.
• Work with back office staff and providers to clarify documentation and coding concerns.
• Assist with payment review and reconciliation as needed.
• Identify payment discrepancies and coordinate corrections.
• Ensure adjustments, write-offs, and refunds are processed according to organizational policies.
• Maintain compliance with HIPAA, federal and state regulations, and payer guidelines.
• Stay current with CPT, HCPCS, ICD-10, and payer billing requirements.