Hospital Accounts Receivable Specialist

(Medicare & Medicaid Institutional and Professional Billing)

Full-Time | Hybrid

Base Salary: $23.35–$26.39/hour (commensurate with experience)

Hours: 8:00 am – 4:30 pm

The Hospital Accounts Receivable Specialist reports to the Manager of Patient Accounts. The specialist manages Medicare and Medicaid institutional and professional accounts throughout the revenue cycle. This role is responsible for claim review, insurance follow-up, denial resolution, claim corrections, appeals, payment research, and account documentation, all to support accurate and timely reimbursement.

We are looking for someone with hands-on institutional (hospital/facility) billing experience. The ideal candidate already knows government payer requirements and institutional coding guidelines. They can spot what is wrong with a claim and fix it, and they can help strengthen a team that is growing into hospital billing. We will train you on our systems; the institutional billing expertise is what you bring.

What You'll Do

• Review institutional and professional claims for accuracy, completeness, coding consistency, authorization status, and payer requirements.
• Apply Medicare and Medicaid institutional billing guidelines, including revenue codes and APG reimbursement, to ensure clean claim submission.
• Validate patient, provider, insurance, coding, and billing information to ensure accurate reimbursement.
• Research and resolve claim edits, clearinghouse rejections, denials, underpayments, unpaid claims, billing discrepancies, and reimbursement issues.
• Prepare and submit corrected, replacement, voided, and appealed claims in accordance with payer guidelines and timely filing requirements.
• Prepare, print, and mail paper claims on on-site days as needed.
• Follow up on outstanding insurance and patient balances through final account resolution.
• Research payer policies, reimbursement guidelines, and claim requirements using payer portals and available resources.
• Review remittance advice, claim history, account documentation, and billing records to determine root causes and resolve payment issues.
• Support compliance with Medicare and Medicaid billing and reporting requirements.
• Identify recurring denial trends and reimbursement issues, and escalate process improvement opportunities to leadership.
• Collaborate with and support team members developing institutional billing skills.
• Maintain accurate, timely documentation of all account activity in the billing system.
• Comply with organizational policies and regulatory requirements, and perform other duties as assigned.

What You'll Bring (Required)

• Institutional billing experience: At least 2 years of hands-on institutional billing experience, gained in a hospital, health system, or billing agency/vendor servicing hospital or facility accounts. Physician-office-only billing experience does not meet this requirement.
• Government payers: Required experience billing Medicare and Medicaid for both institutional and professional claims.
• Professional billing: Experience with professional claims.
• Overall experience: 2–5 years of experience in hospital patient accounts, healthcare billing, insurance follow-up, denial management, or revenue cycle operations.
• Institutional coding knowledge: Working knowledge of revenue codes and APG (Ambulatory Patient Group) reimbursement, as well as CPT, HCPCS, ICD-10, NCCI edits, medical necessity, and authorization requirements.
• Compliance: Familiarity with Medicare and Medicaid billing compliance and reporting requirements.
• Strong knowledge of claims processing, accounts receivable, appeals, denial management, and outpatient reimbursement methodologies.
• Ability to interpret remittance advice, claim status responses, and payer correspondence.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Ability to prioritize competing deadlines while maintaining accuracy and meeting timely filing requirements.
• Excellent communication skills and the ability to build positive relationships with patients, payers, and colleagues.
• Proficiency in Microsoft Office.

Nice to Have

• Experience with a hospital billing system such as Epic.
• Raintree experience is a strong plus. Training on Raintree and our other systems is provided.
• Experience with Waystar, Inovalon, Wellpoint Federal, or ePaces.
• Commercial payer billing experience.

Benefits

• Rest, Reset & Recharge: 2 weeks PTO; Sick time in accordance with state and local requirements; plus 6 major holidays.
• Plan Ahead: Company-matched 401(k) available once eligibility requirements are met.
• Commute Smart: Pre-tax transit and parking benefits through WageWorks.
• Care for Your Crew: MetLife Pet Insurance with flexible plans and 24/7 telehealth support.
• Play More, Pay Less: Exclusive discounts through PlumBenefits and LifeMart.

Equal Opportunity Employer, including Disabled/Veterans.

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