Accounts Receivable Specialist - Hospitals

The Accounts Receivable Specialist is responsible for effective collection of patient accounts, accounts receivable follow-up, and reimbursement analysis for non-government accounts to support timely and maximum reimbursement for client hospitals.

Key responsibilities include managing assigned accounts to ensure outstanding and pending claims are resolved and paid appropriately, requesting claim reprocessing and submitting corrected claims when needed, and following up on outstanding insurance claims beginning 30 days from date of service. The role also includes reviewing and resolving credit balance accounts, payer and patient refund requests, misapplied payments, returned claims, correspondence, denials, account reconciliations, and rebills.

The position requires identifying denial trends and communicating them to Revenue Cycle leadership, maintaining knowledge of insurance guidelines and billing requirements, obtaining supporting documentation from facilities to resolve claims, and ensuring compliance with state and federal regulations, payer guidelines, and company policies. The specialist will also assist with revenue cycle process improvements, maintain confidentiality, and support special projects as assigned.

Behavioral expectations include strong customer service, professionalism, accountability, participation in meetings and training, adherence to company code of conduct, and support of the mission, vision, and goals of Avem Health Partners.