Accounts Receivable/Medical Billing Specialist

Position Summary:

The Accounts Receivable (AR) Specialist manages the front-end billing and revenue collection cycle for the health center. This role ensures timely reimbursement from Medicaid, Medicare, managed care organizations (MCOs), commercial insurance, and patients. The ideal candidate must have deep expertise in community health billing, HRSA compliance, sliding fee scales, medical denial management, and self-pay client management.

Primary Responsibilities:

• Daily Clinic Balancing: Reconcile daily front-desk cash logs, checks, and credit card batches against the practice management schedule reports before routing funds to General Accounting in the Financial Solution.

• Generate and enter Charges: On a monthly basis, generate, classify, and enter charges into client accounts. Classify total revenue into specialty groups.

• Claims Management: Prepare, scrub, and electronically submit clean medical, dental, and behavioral health claims to payers via the clearinghouse daily.

• Payment Posting: Post insurance Electronic Remittance Advices (ERAs), Explanation of Benefits (EOBs), and patient payments to patient accounts accurately.

• Sliding Fee Scale Administration: Apply HRSA-compliant sliding fee discounts to patient accounts based on verified family size and income data; audit self-pay patient balances.

• Denial & Appeal Tracking: Analyze, correct, and resubmit rejected or denied claims. File formal appeals with insurance companies to ensure maximum, timely reimbursement.

• Additional Duties: Additional finance duties as assigned

Qualifications:

• Experience: Minimum 2–3 years of medical billing and accounts receivable experience, ideally within an FQHC or community health setting.

• Certification: Associate or bachelor's degree in accounting/business management and a Certified Professional Biller (CPB).

• Software: High comfort level with accounting software and Microsoft Excel, proficiency with major EHR/Practice Management software (e.g., Athenahealth, eClinicalWorks, NextGen).

• Skills:

• Data accuracy, basic accounting, strong understanding of CPT, ICD-10, and HCPCS codes; knowledge of Medicaid/Medicare guidelines will be an advantage