Key Responsibilities and Required Skills for Medical Accounts Receivable Specialist

🎯 Role Definition

The Medical Accounts Receivable Specialist is responsible for managing patient and payor receivables across the healthcare revenue cycle, maximizing timely reimbursement, reducing outstanding AR days, and resolving denials and billing discrepancies. This role blends medical billing and claims follow-up, payer negotiation, patient account reconciliation, and detailed reporting to support cash flow and compliant revenue recognition. Ideal for candidates experienced with EHR/EMR platforms (Epic, Cerner, Athenahealth), payer portals, CPT/ICD-10 fundamentals, and HIPAA-compliant patient communications.

📈 Career Progression

Typical Career Path

Entry Point From:

Medical Biller / Billing Clerk
Patient Accounts Representative / Front-End Patient Services
Insurance Claims Processor

Advancement To:

Senior Accounts Receivable Specialist / Lead A/R Analyst
Revenue Cycle Supervisor / Manager
Billing Operations Manager / Director of Revenue Cycle

Lateral Moves:

Insurance Claims Specialist / Denials Analyst
Patient Financial Counselor / Financial Clearance Specialist

Core Responsibilities

Primary Functions

Conduct proactive claims follow-up with commercial insurers, Medicare, and Medicaid payers to obtain outstanding reimbursement and reduce days in accounts receivable, documenting each contact and outcome in the EHR or billing system.
Manage denial prevention and appeals by analyzing denial reasons, generating and submitting evidence-based appeals, and tracking appeals status to ensure maximum allowable reimbursement.
Review and post patient and payer payments to patient accounts, reconcile remittance advice (ERA/EDI), and investigate any payment discrepancies or short pays to correct underpayments promptly.
Perform daily and weekly aging analysis of AR buckets, prioritize accounts for follow-up based on aging, liability, and likelihood of recovery, and prepare actionable task lists for collection efforts.
Validate insurance eligibility and benefits for billed services and coordinate retroactive authorizations or re-submissions when eligibility changes affect reimbursement.
Prepare, submit, and track corrected claims (resubmissions, voids, reversals) with accurate modifiers, CPT/HCPCS, and ICD-10 coding references to resolve claim errors and optimize payment.
Collaborate closely with clinical departments, coders, and physician offices to gather missing documentation, clarify procedure codes, and support clinical documentation improvement that impacts billing accuracy.
Handle patient billing inquiries, explain outstanding balances, review benefit explanation of benefits (EOBs) with patients, and establish payment arrangements or financial assistance referrals when appropriate.
Escalate complex or high-dollar payer disputes to payer relations or contract management and follow through to resolution while maintaining detailed case notes.
Utilize practice management and billing systems (e.g., Epic Resolute, Cerner Billing, AthenaCollector, Kareo, NextGen) for claim workflow, posting, and reporting functions.
Execute patient account reconciliations, including adjustments, write-offs, and refunds in accordance with organizational policies and revenue recognition practices.
Research and correct coding and billing errors identified during internal audits, payer audits, or post-payment reviews to minimize recoupments and compliance risk.
Generate and distribute AR performance reports and key performance indicators (KPIs) such as net collection rate, clean claim rate, denial rate, and AR days to revenue cycle leadership.
Implement and monitor denial trend reporting to identify root causes and design corrective action plans in partnership with clinical coding, revenue integrity, and payer contracting teams.
Conduct timely electronic and paper claim submissions, including batch management, 837/HCFA transmissions, and payer portal uploads, ensuring adherence to payer-specific submission rules.
Coordinate with third-party collection agencies and legal vendors for accounts meeting escalation criteria while ensuring compliance with state collection laws and HIPAA privacy protections.
Maintain accurate documentation of payer conversations, appeal submissions, and denials management steps to support audit trails and regulatory compliance.
Train and mentor junior billing staff or cross-train teammates on payer-specific requirements, follow-up tactics, and system navigation to improve team efficiency.
Respond to medical record requests, produce superbills and encounter documents for claim appeals, and work with HIM/Coding to obtain missing reports that affect claim adjudication.
Reconcile bank deposits and batch reports for posted payments and provide detailed explanations for variances between banked receipts and posted ledger amounts.
Negotiate with payers on underpaid claims, bundled services, and complex contract interpretations to obtain corrected payment or appropriate adjustments.
Support periodic external audits and payer audit responses by assembling documentation and explanation packages for reviewed claims.
Monitor regulatory and payer policy changes (e.g., Medicare rules, MAC instructions, telehealth reimbursement updates) and adapt AR workflows to maintain compliance and revenue capture.

Secondary Functions

Support ad-hoc reporting requests and assist in compiling data for month-end and quarter-end revenue reconciliations and audits.
Participate in cross-functional revenue cycle improvement projects, process redesigns, and system optimization initiatives to improve AR performance.
Assist in the implementation and testing of new billing modules, EDI setups, payer enrollments, and system upgrades, validating claim output and posting logic.
Provide input to training materials and SOPs for billing and AR processes; maintain up-to-date process documentation for team reference.
Liaise with credentialing and contracting teams when payer enrollment or contract terms affect claims submission and payment.
Escalate technology or workflows issues to IT/Billing vendor support and validate fixes in a test environment before live deployment.

Required Skills & Competencies

Hard Skills (Technical)

Proficient knowledge of medical billing processes including charge capture, claim submission, ERA/EDI posting, and refund processing.
Strong understanding of CPT, HCPCS, and ICD-10 coding concepts as they relate to charge capture and claims adjudication.
Experience with major EHR/EMR and practice management systems such as Epic (Resolute/Revenue Cycle), Cerner, Athenahealth, NextGen, or Kareo.
Skilled in denial management workflows, root cause analysis, and drafting evidence-based appeals for commercial and government payers.
Familiarity with payer portals, HIPAA-compliant EDI transactions (837, 835, 270/271), and clearinghouse operations.
Proficiency with Excel (VLOOKUP, pivot tables, filters) and experience creating AR aging and KPI dashboards.
Ability to read and interpret remittance advice (EOB/ERA), payer contracts, and reimbursement rules to identify underpayments.
Experience with accounts reconciliation, adjustments, write-offs, and cash posting best practices.
Knowledge of state and federal healthcare reimbursement regulations, Medicare/Medicaid billing rules, and compliance requirements.
Strong documentation skills for maintaining accurate audit trails and claim histories in billing systems.
Comfortable working with denial trend analytics tools, BI reports, or revenue cycle reporting modules.
Familiarity with consumer-friendly billing practices, patient financial counseling, and payment plan setup.

Soft Skills

Excellent verbal and written communication for interacting with patients, providers, payers, and cross-functional teams.
Strong problem-solving skills and attention to detail to diagnose complex billing discrepancies and resolve them efficiently.
Customer-service orientation when working with patients on account balances, while preserving compliance and privacy.
Time management and prioritization skills to balance high-volume follow-up and aging management tasks.
Analytical mindset to interpret AR metrics, identify trends, and make data-driven recommendations to leadership.
Collaborative attitude for working in multidisciplinary teams (coding, clinical, IT, finance) to improve revenue outcomes.
Resilience and persistence when following up on slow or resistant payers and when handling repeated denials or appeals.
Adaptability to changing payer rules, system updates, and evolving revenue cycle processes.

Education & Experience

Educational Background

Minimum Education:

High school diploma or GED; strong preference for additional coursework in healthcare administration, medical billing, or accounting.

Preferred Education:

Associate degree or Bachelor's degree in Health Information Management, Healthcare Administration, Accounting, Finance, or related field.
Certifications such as Certified Revenue Cycle Representative (CRCR), Certified Medical Reimbursement Specialist (CMRS), or Certified Professional Biller (CPB) are a plus.

Relevant Fields of Study:

Health Information Management / Medical Billing
Healthcare Administration
Accounting, Finance, or Business Administration

Experience Requirements

Typical Experience Range:

1–5 years of direct medical billing or accounts receivable experience in a physician practice, hospital billing office, or billing service bureau.

Preferred:

3+ years of progressive experience managing AR, denials, and payer relations with documented success reducing AR days and denial rates; demonstrated experience with EHR systems such as Epic or Athenahealth and familiarity with Medicare/Medicaid processes.