The Healthcare Accounts Receivable (A/R) Specialist is responsible for managing the complete revenue cycle process related to either hospital (HB) or professional (PB) billing accounts, depending on assignment. This includes insurance follow-up, denial resolution, and account reconciliation. The A/R Specialist ensures that outstanding balances are accurately resolved with insurance payers in a timely manner.
This position requires strong knowledge of payer-specific guidelines, EDI transactions, and reimbursement methodologies across commercial, government, and managed care plans. Assignments may be separated by billing type (HB or PB), allowing the A/R Specialist to focus on the nuances of each area. Direct communication with insurance carriers, patients, and internal departments is essential to facilitate successful resolution of accounts and maintain excellent customer service.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Accounts Receivable Management – Insurance Focused:
- Manage assigned A/R inventory for either hospital (UB-04 / 837I) or professional (CMS-1500 / 837P) claims, based on designated work queue.
- Perform timely follow-up and resolution of unpaid, rejected, or denied insurance claims.
- Submit corrected claims, appeals, and required documentation to secure appropriate reimbursement.
- Reconcile outstanding account balances to ensure accuracy of payments and adjustments.
- Monitor aging reports and prioritize accounts based on payer guidelines and internal timelines.
Insurance Account Management:
- Maintain deep knowledge of payer-specific rules, coverage policies, and authorization requirements.
- Analyze remittance advice (ERA/EOB) to identify denials, underpayments, or coordination of benefit issues.
- Identify trends in denials or underpayments and collaborate with leadership and internal departments for resolution.
- Validate insurance eligibility and verify benefits when necessary to assist with claim resolution.
- Communicate professionally with payer representatives to resolve claim issues and disputes.
Hospital Billing (HB) Responsibilities:
- Manage inpatient, outpatient, observation, ER, and ancillary hospital claims.
- Address complex billing concerns related to DRG, APCs, and bundled services.
- Collaborate with case management, coding, and HIM to resolve documentation or authorization-related denials.
Professional Billing (PB) Responsibilities:
- Manage billing and claims for physician and clinic visits.
- Ensure proper use of CPT/HCPCS codes, modifiers, and place-of-service indicators.
- Work closely with provider groups for documentation, encounter clarification, and coding questions.
Patient and Internal Communication:
- Respond to patient inquiries regarding insurance claim status, balances, and account questions, as needed.
- Assist patients in understanding insurance coverage, denials, and explanation of benefits (EOBs), as needed.
- Refer patients to Financial Counselors for potential charity or financial assistance when applicable, as needed.
- Collaborate with internal teams including Billing, Registration, Financial Counseling, HIM, and Compliance to improve resolution timelines and reduce denials.
- Compliance and Documentation:
- Maintain clear, timely, and accurate documentation of all account activities and payer communications.
- Ensure all actions comply with HIPAA, FDCPA, CMS regulations, and internal policies.
- Participate in audits, staff meetings, training, and corporate compliance initiatives as required.
OTHER RESPONSIBILITIES
- Strong problem-solving abilities and attention to detail.
- Ability to manage competing priorities and meet strict deadlines.
- Customer service-focused mindset.
- Comfortable working independently as well as in a team environment.
- Maintains confidentiality and professionalism at all times.
(The above statements describe the general nature and level of work being performed. They are not intended to be an exhaustive list of all duties, and indeed additional responsibilities may be assigned, as required, by Hillsboro Health.)
SUPERVISORY RESPONSIBILITIES
None
EDUCATION AND/OR EXPERIENCE
- High school diploma or equivalent required; associate degree in business, healthcare, or related field preferred.
- Minimum 2–3 years of healthcare A/R experience, including:
- Hospital billing (UB-04 / 837I) or
- Professional billing (CMS-1500 / 837P)
- Strong knowledge of insurance processes, billing workflows, and reimbursement methodologies.
- Experience with denial resolution and insurance account follow-up.
- Familiarity with electronic billing systems and EHR platforms (e.g., Epic, Meditech, TruBridge, CPSi, Oracle Health).
- Strong analytical, organizational, and communication skills.
- Ability to explain complex billing concepts clearly and professionally.
- Experience with EFT/ERA processing, EDI transactions, and payer portal utilization.
- Bilingual (English/Spanish or other language) is a plus.
CERTIFICATES, LICENSES, REGISTRATIONS
None
PHYSICAL DEMANDS & WORK ENVIRONMENT
- Office-based position with frequent contact with insurance representatives, internal teams, and patients.
- Regular use of computer, phone, and standard office equipment.
- Prolonged sitting; occasional lifting up to 25 pounds.
- May require extended hours during month-end, special projects, or peak billing cycles.
CORPORATE COMPLIANCE
Receives training and/or attends necessary meetings to meet the criteria as outlined in Hillsboro Health’s Corporate Compliance Plan and Code of Conduct. Understands the responsibilities related to compliance and knows how to contact the Corporate Compliance Officer should there be any instance of question or concern regarding fraud and/or abuse.
BENEFITS
Please use the link below to visit our website for a list of benefits offered.