Medical Billing Insurance Accounts Receivable Specialist I

NO WEEKENDS, NO EVENINGS, NO HOLIDAYS

 We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

Benefits:

· Health insurance

· Dental insurance

· Vision insurance

· Life Insurance

· Pet Insurance

· Health savings account

· Paid sick time

· Paid time off

· Paid holidays

· Profit sharing

· Retirement plan

GENERAL SUMMARY

The Insurance Accounts Receivable Specialist I is responsible for performing entry-level insurance billing and follow-up tasks to support timely and accurate reimbursement. This includes submitting claims, reviewing basic denials, and conducting follow-up on outstanding balances under supervision. The role focuses on learning workflows, applying standard procedures, and escalating more complex issues as needed. 

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Perform billing-related tasks as assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving entry-level insurance denials, such as those related to medical records, eligibility, and coordination of benefits (COB).
• Complete daily tasks within assigned work queues based on manager direction and established workflows.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to determine appropriate actions for resolving unpaid or underpaid claims and authorizing procedures.
• Identify potential issues related to payer requirements, provider credentialing, or coding, and escalate to management as appropriate.
• Review reports to identify unpaid claims and potential revenue opportunities.
• Communicate effectively with providers, patients, coders, and other stakeholders to ensure accurate and timely claims processing.
• Adhere to departmental workflows, operational policies, compliance guidelines, and regulatory requirements, including FGP and patient confidentiality standards.
• Provide input on system edits, process improvements, policies, and billing procedures to support revenue cycle optimization.
• Participate in meetings and workgroups, complete all required training sessions, and actively seek additional training when needed.
• Read and apply policies and procedures to make informed decisions, coordinate functions with team members, and explain processes clearly to others.
• Make system corrections and resubmit claims as necessary to meet payer requirements.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Excellent interpersonal and communication skills.
• Strong customer service orientation and a friendly, approachable demeanor.
• Basic knowledge of medical facility layout and department functions (training provided).
• Dependability and punctuality.
• Ability to work independently and as part of a team.
• Cultural sensitivity and ability to interact respectfully with diverse populations.
• Skill in using computer programs and applications including Microsoft Office.

EDUCATION REQUIREMENTS

• High school diploma or equivalent required.

EXPERIENCE REQUIREMENTS

• Previous experience in a customer service or healthcare setting preferred.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%