Job Summary

The RCM Accounts Receivable Specialist is responsible for resolving outstanding insurance accounts receivable through proactive follow-up, denial management, appeals, and payer communication. This role focuses on maximizing reimbursement, identifying denial trends, and driving revenue cycle performance improvements for assigned client accounts.

Success in this role requires strong analytical skills, a deep understanding of healthcare reimbursement processes, and extensive daily use of Microsoft Excel and Outlook to manage account inventories, communicate with payers, track claim activity, and analyze denial trends.

Responsibilities

• Manage a portfolio of outstanding insurance accounts receivable, ensuring timely follow-up and resolution of unpaid or underpaid claims.
• Perform end-to-end denial management, including researching claim denials, identifying root causes, submitting appeals, and securing appropriate reimbursement.
• Analyze denial patterns and reimbursement trends to identify opportunities for process improvement and revenue recovery.
• Contact insurance carriers via phone, email, fax, payer portals, and written correspondence to resolve claim issues and payment delays.
• Investigate and resolve claim edits, rejections, authorization issues, coding discrepancies, and payer-specific reimbursement concerns.
• Follow up on aged accounts and claims with no response from insurance carriers while maintaining productivity and quality standards.
• Utilize Microsoft Excel to track accounts, analyze payer trends, manage work queues, create reports, and maintain denial inventories.
• Utilize Microsoft Outlook extensively for communication with payers, clients, and internal stakeholders regarding claim resolution activities.
• Review and apply current federal, state, Medicare, Medicaid, and payer-specific billing regulations.
• Handle Electronic Data Interchange (EDI) transactions, including reconciliation of carrier submissions, clearinghouse edits, and rejection reports.
• Leverage RPA tools and AI-assisted workflows to enhance efficiency, automate routine follow-up activities, and improve claim resolution outcomes.
• Maintain detailed documentation of account activity and claim resolution efforts.

Required Qualifications

• High school diploma or GED.
• Minimum of 1 year of healthcare accounts receivable, medical billing, or denial management experience.
• Demonstrated experience researching and resolving insurance claim denials and payer reimbursement issues.
• Advanced Microsoft Excel skills, including VLOOKUPs/XLOOKUPs, Pivot Tables, filters, formulas, and spreadsheet management.
• Strong proficiency in Microsoft Outlook, including managing high-volume email communications and claim follow-up correspondence.
• Understanding of insurance reimbursement processes, claim adjudication, Medicare, Medicaid, and commercial payer requirements.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent verbal and written communication skills.
• Demonstrated ability to manage productivity metrics and work independently in a fast-paced environment.

Preferred Qualifications

• Experience in behavioral health, post-acute care, home health, long-term care, or specialty healthcare billing.
• 2+ years of insurance AR follow-up and denial management experience.
• Collections experience within a healthcare revenue cycle environment.
• Experience preparing and submitting formal appeals to insurance carriers.
• Working knowledge of medical billing systems such as Medic, IDX, Avatar, Tier, Medical Manager, or similar platforms.
• Experience with automation tools, AI-enabled workflows, or revenue cycle technology solutions.

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Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

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