应收账款专员
Accounts Receivable Specialist
账户应收专员 — 运营 · 菲律宾 – 远程
Summit360 Solutions 正在寻找一位经验丰富的账户应收专员加入菲律宾 – 远程的运营团队。你将在一个注重精确性、安全性和专业性的协作团队中发挥关键作用，为我们的客户提供高质量成果。
职位概述
应收账款（AR）专员负责及时跟进、跟踪和解决 Medsense Health 四家提供方实体的未付和部分支付的保险索赔。该职位与收入周期经理密切合作，减少 AR 天数，解决拒付问题，并确保从 Medicare、Medicaid 和商业付款人处获得干净、及时的报销。
主要职责
• 通过付款人门户（Availity、NGSConnex、Novitasphere、Palmetto GBA eServices、WPS SNAP、Payspan、ECHO Health、Blue e、UHC 等）和付款人电话线，对所有四家 Medsense Health 实体的未结保险索赔进行每日跟进。
• 根据索赔年龄、金额和付款人及时提交截止日期，优先处理其队列中的索赔，确保所有分配的索赔在预期的处理时间内得到处理。
• 监控应收账款老化报告，并根据索赔年龄、金额和付款人及时提交截止日期优先跟进。
• 调查并解决索赔拒付和拒绝，识别根本原因（例如编码错误、服务点错误、责任重叠问题、缺失授权、资格问题），并将更正操作转交给相应的团队成员。
• 在计费/索赔系统中以一致的格式（采取的行动、结果、下一步）记录所有跟进活动、付款人沟通和下一步计划。
• 升级需要医疗记录、上诉或额外文件的索赔，并跟踪提交截止日期（例如预付款审查请求、上诉窗口）。
• 识别并标记重复的拒付趋势或特定付款人的问题，向收入周期经理报告以进行流程修正。
• 支持协调利益（COB）跟进、次级索赔提交和解决主次付款人不匹配问题。
• 在所有付款人和内部沟通中严格遵守 HIPAA 和 PHI 处理要求。
• 根据需要协助特殊项目，如大规模索赔更正、付款人审计或电子资金转账/电子清算通知（EFT/ERA）注册跟进。
任职要求
• 2 年以上医疗账款、医疗计费或相关领域的工作经验，如
查看英文原文
Account Receivables Specialist — Operations · Philippines – Remote
Summit360 Solutions is seeking an experienced Account Receivables Specialist to join our Operations team in Philippines – Remote. You'll play a pivotal role in delivering high-quality outcomes for our clients, working alongside a collaborative team that values precision, safety, and craft.
Position Summary
The Accounts Receivable (AR) Specialist is responsible for the timely follow-up, tracking, and resolution of unpaid and underpaid insurance claims across Medsense Health's four provider entities. This role works closely with the Revenue Cycle Manager to reduce days in AR, resolve denials, and ensure clean, timely reimbursement from Medicare, Medicaid, and commercial payers.
Key Responsibilities
• Perform daily follow-up on outstanding insurance claims across all four Medsense Health entities via payer portals (Availity, NGSConnex, Novitasphere, Palmetto GBA eServices, WPS SNAP, Payspan, ECHO Health, Blue e, UHC, and others) and payer phone lines.
• Prioritize and work claims assigned in their queue based on claim age, dollar value, and payer timely-filing deadlines, ensuring all assigned claims are addressed within expected turnaround times.
• Monitor aging AR reports and prioritize follow-up based on claim age, dollar value, and payer timely-filing deadlines.
• Investigate and resolve claim denials and rejections, identifying root cause (e.g., coding errors, POS errors, COB issues, missing authorizations, eligibility issues) and routing corrections to the appropriate team member.
• Document all follow-up activity, payer communications, and next steps in the billing/claims system using a consistent format (action taken, outcome, next step).
• Escalate claims requiring medical records, appeals, or additional documentation, and track submission deadlines (e.g., prepayment review requests, appeal windows).
• Identify and flag recurring denial trends or payer-specific issues to the Revenue Cycle Manager for process correction.
• Support coordination of benefits (COB) follow-up, secondary claim submission, and resolution of primary/secondary payer mismatches.
• Maintain strict compliance with HIPAA and PHI handling requirements in all payer and internal communications.
• Assist with special projects as needed, such as large-scale claim corrections, payer audits, or EFT/ERA enrollment follow-up.
Qualifications
• 2+ years of experience in healthcare accounts receivable, medical billing, or claims follow-up, ideally across multiple provider entities or a multi-payer environment.
• Working knowledge of Medicare Part B, Medicaid, and commercial payer claim requirements.
• Familiarity with common payer portals and clearinghouses (e.g., Availity, NGSConnex, Novitasphere, Payspan, ECHO Health) strongly preferred.
• Understanding of CPT, ICD-10, and POS coding as it relates to claim denials and corrections.
• Strong written communication skills for professional payer correspondence.
• Highly organized, detail-oriented, and comfortable managing a high volume of concurrent claims across multiple entities.
• Ability to work US business hours.
Preferred Experience
• Experience with telehealth, RPM/RTM billing, or preventive medicine billing models.
• Experience with denial management, prepayment reviews, or payer audits.
• Experience supporting credentialing or payer enrollment processes a plus.
Reports To
Revenue Cycle Manager
Originally posted on Himalayas