Medical Accounts Receivable Specialist

Medical Accounts Receivable Specialist San Diego, CA, United States Medical AR Specialist Under general supervision and with a high level of knowledge, skills and experience, the Medical Accounts Receivable Specialist performs a variety and full range functions related to Biotheranostics customer service, billing, appeals and accounts receivable resolution. Functions include but are not limited to billing, Third Party Payer follow-up, trend and A/R analysis, account inquiry resolution and appeals. In addition to specific duties, position may assist in other areas as needed to minimize risks related to achieving financial performance. Primary Responsibilities: + Timely, effective follow up and maximize collection of assigned Third Party Payer outstanding A/R and denials. + Responsible for reviewing and submitting first level appeals to insurance companies, collaborating with Level 3 reps on second level appeals and forwarding third level appeals to Level 3 reps to submit (level 3 appeals include: external appeals (DOI complaints & CMS complaints), member appeals) + Analysis and timely reporting related to Third Party Payer A/R, denials and overall payer performance. + Investigate rejected claims to see why denials were issued and correct claims within the timeline period, while closely working with the provider associated with specific claim(s). + Trend, payer issue, cash flow disruption identification, tracking, reporting and resolution. + Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments/refund requests. + Reports new/unknown billing edits to direct supervisor for review and resolution. + Identify, report root causes associated with denials. + Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests) + Reviews and completes payor correspondence in a timely manner. + Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation ofappeal outcomes (i.e., next steps, improved outcomes) + Intermediate knowledge of Billing system, tools and resources to support cash collection activities. + Keep current with all payer regulations, guidelines and provider/payer contract terms. + Effectively manage incoming calls, resolve internal and external customer inquiries regarding all aspects of patient and/or client accounts + Support and maintain department cash and DSO goals. + Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy. + Performs additional tasks, projects, special assignments as required. + Works independently with Level 3 guidance. + Actively participates in team meetings, provides insight when asked. + Meets Level 2 daily and monthly productivity requirements. Qualifications: + High school diploma (or GED equivalent) + Minimum 3 plus yearsu2019 experience- all aspects of patient account management and resolution with an emphasis in Third Party Payers, A/R and denial resolution, preferably in a laboratory environment + Must be able to demonstrate strong knowledge of commercial and government health plan requirements, guidelines, billing practices and regulations. + Support cross-trained culture. + Ability to easily adapt to increased business demands. + Ability to effectively work with and resolve complex accounts & billing issues. + Self-starter, ability to work independently. + Excellent troubleshooting and time management skills, attention to detail, utilizes time in a constructive manner. + Flexible and reliable + Ability to effectively prioritize and multi-task. + Ability to work in a fast-paced environment, perform under pressure, meet tight timelines. + Establish and maintain cohesive and good working relationships. + Excellent communication and customer service skills; cooperative, work collaboratively and treat others in respectful,professional and supportive manner. + Working knowledge of ICD-10, CPT, LCD/NCD and reimbursement associated with such codes. + Ensures compliance with all state and federal billing HIPAA regulations. + Strong knowledge and experience with Microsoft Excel as well as Word and Outlook, general office equipment, ten key by touch + Desire to learn and apply learned concepts to various situations. + Some Xifin Experience Why Join Hologic? In this Medical Accounts Receivable Specialist role at Hologic, you will play a pivotal role in shaping the future of womenu2019s health. Youu2019ll have the opportunity to lead impactful initiatives, collaborate with talented professionals, and drive meaningful change in a company committed to making a difference in the lives of women worldwide. We offer a competitive salary, annual bonus, and wide-ranging benefits policy including medical and dental insurance, 401(k) plan, vacation, sick leave and holidays, parental leave and many more If you have the right skills and experience and want to join our team, apply today. We canu2019t wait to hear from you Additional Info: The annualized base salary range for this hourly role is $49,200 to $73,800 and is bonus eligible. Final compensation packages will ultimately depend on factors including relevant experience, skillset, knowledge, geography, education, business needs and market demand. _Agency and Third-Party Recruiter Notice:_ _Agencies that submit a resume to Hologic must have a current executed Hologic Agency Agreement executed by a member of the Human Resource Department. In addition, Agencies may only submit candidates to positions for which they have been invited to do so by a Hologic Recruiter. All resumes must be sent to the Hologic Recruiter under these terms, or they will not be considered._ _Hologic, Inc. is proud to be an Equal Opportunity Employer inclusive of disability and veterans._ #LI-LW1

Created: 2026-02-05