Insurance Follow-Up Representative

Job Title: Accounts Receivable Specialist – Physician AR

Department: Revenue Cycle
Reports to: Accounts Receivable (AR) Manager

Position Summary:

The Accounts Receivable (AR) Specialist is responsible for managing and resolving outstanding accounts receivable balances related to physician services. This position plays a critical role in the revenue cycle by following up on unpaid claims, analyzing denials, and ensuring timely and accurate reimbursement from third-party payers and patients. The AR Specialist works closely with insurance companies, patients, and internal departments to identify and resolve billing issues, ensuring optimal cash flow and compliance with payer guidelines.

Key Responsibilities:

• Follow up on outstanding receivables with third-party payers and patients to ensure timely payment.
• Analyze and resolve denied or underpaid claims; identify root causes and recommend corrective actions.
• Review and work claim edits, rejections, and denials to ensure claims are corrected and resubmitted as appropriate.
• Respond to patient inquiries regarding account balances and insurance billing.
• Maintain accurate and detailed documentation of all collection activities in the billing system.
• Make outbound calls and/or send written correspondence to patients and payers to secure payment or obtain information.
• Escalate complex issues to the AR Manager or other appropriate departments for resolution.
• Assist with special projects and audits related to billing, collections, or compliance.
• Ensure compliance with all federal, state, and payer-specific billing regulations.
• Collaborate with the billing and coding team to correct claim errors and prevent future denials.
• Other duties as assigned.

Education & Experience:

• High school diploma or equivalent required.
• Minimum 3-5 years of experience in healthcare accounts receivable, medical billing, or collections required.
• Experience in physician billing is strongly preferred.
• Familiarity with government and commercial insurance payers, including Medicare, Medicaid, and private health plans.
• Working knowledge of electronic health record (EHR) and billing systems; EPIC experience is a strong plus.

Knowledge, Skills & Abilities:

• Solid understanding of medical billing, insurance claim processes, and denial management.
• Excellent verbal and written communication skills; ability to explain complex billing issues in a clear, patient-friendly manner.
• Strong customer service skills with the ability to manage difficult conversations professionally.
• High attention to detail and accuracy in data entry and account reconciliation.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Proficient in Microsoft Office, especially Excel and Word.
• Ability to maintain confidentiality of patient and financial information in compliance with HIPAA regulations.