Medical Billing Account Receiveable Representative

Medway Billing & IT Solutions is seeking a highly skilled and detail-oriented Medical Billing Account Receivable Representative to manage outstanding insurance claims and maximize timely reimbursements. This role focuses on following up on unpaid, denied, and underpaid claims, conducting denial investigations, and coordinating with multiple teams to improve billing accuracy and collections. A strong background in medical billing, specifically in orthopedics, and expertise in insurance payer guidelines are essential for success in this position. The ideal candidate has a minimum of 2 years of experience handling U.S. medical billing and accounts receivable, with proficiency in relevant coding and billing systems. The representative plays a key role in maintaining accurate claim information, submitting appeals, and ensuring compliance with payer-specific requirements. They independently manage assigned accounts, prioritize high-dollar and aging claims, and work with coding, authorization, and payment posting teams to resolve discrepancies. Candidates with hands-on experience in AthenaOne/Athenahealth and knowledge of orthopedic billing practices, including office visits, surgeries, injections, physical therapy, imaging, and durable medical equipment, will have an advantage. This role does not involve managing a team but requires strong analytical, communication, and organizational skills to meet productivity and collection targets effectively.
Responsibilities

Follow up on unpaid, underpaid, and denied insurance claims to accelerate payments and reduce accounts receivable aging.
Review and analyze accounts receivable aging reports, prioritizing high-dollar and older claims for immediate action.
Investigate the root causes of denials and take corrective measures, including claim corrections and resubmissions.
Prepare and submit reconsiderations and appeals with detailed supporting documentation to recover denied payments.
Verify claim statuses through insurance payer portals and direct communication with insurance representatives.
Correct and resubmit claims involving coding errors, modifier use, authorization issues, eligibility, or demographic inaccuracies.
Review payments against contracted insurance rates, identify underpayments, and initiate recovery processes.
Maintain comprehensive and accurate notes in the billing system to document all claim activities and correspondence.
Manage insurance recoupments, refund requests, and resolve discrepancies related to claim payments.
Collaborate closely with coding, authorization, charge-entry, and payment-posting teams to ensure billing accuracy and compliance.
Meet established productivity, quality standards, and collection targets while adhering to company billing policies.
Utilize payer portals such as Availity and other insurance websites for claim management and verification.
Apply strong knowledge of commercial insurance, Medicare, Medicaid, and workers' compensation to navigate various payer guidelines effectively.
Employ a thorough understanding of CPT codes, ICD-10 codes, modifiers, and medical terminology relevant to orthopedic billing.
Use AthenaOne/Athenahealth systems for billing tasks, where applicable, to streamline claims management.
Address authorization-related denials, bundling issues, medical necessity denials, coding denials, and underpayments to improve revenue cycle performance.