Accounts Receivable Specialist – Oral Surgery

🕒 June 25

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HighFive Healthcare

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501 - 1000 employees

You’re already on top of your game; we’re just helping you raise the bar.

📋 Description

• Investigate, appeal, and resolve denied or rejected claims by insurance payors. • Work with insurance companies to clarify discrepancies and ensure proper reimbursement. • Review and assess Explanation of Benefits (EOBs) at the claim level to determine issues. • Determine root cause of any billing related or claim submission issues to prevent recurrence. • Make corrections to claims based on denials and rebill utilizing standardized process and procedures. • Follow up with unresolved claims through system resources, clearinghouse, payer portal or call to the payor, when necessary. • Assess whether an appeal is required for a claim denial. • Track appeals to ensure timely payment and resolution. • Spot recurring patterns in denials and report them to management for further analysis and action. • Effectively communicate both verbally and in writing with team members, payors, patients, and other relevant parties. • Keep up to date with internal processes, industry standards, and government regulations relevant to denial management to ensure compliance and best practices. • Participate in or take on special projects or additional duties as required by the team or management. • Meet or exceed required accounts per day to meet HighFive and provider’s expectations. • Achieve department goals for net collection rates and the resolution of denied claims, including those successfully paid or overturned.

🎯 Requirements

• Oral Surgery billing experience required. • Denial/Claim OR AR Experience with TMJ (temporomandibular joint/orthognathic surgery) • High school diploma or equivalent; associate or bachelor’s degree in healthcare, business, or a related field preferred. • Minimum of 2 years of experience in healthcare billing and accounts receivable. • Knowledge of medical insurance plans, billing procedures, and healthcare reimbursement processes. • Proficiency with Electronic Health Record (EHR) systems and billing software. • Dental billing experience preferred but not required. • Working knowledge of excel and system workflows. • Prior experience with mid or large-scale healthcare business office of 100 or more providers preferred. • Strong attention to detail with the ability to accurately review and process claims. • Excellent communication and problem-solving skills. • Ability to work independently and manage multiple tasks simultaneously. • Knowledge of HIPAA and other healthcare compliance regulations.