RCM Specialist

Category: Other

Location:


Infinit-O is the trusted, customer-centric, and sustainable leader in Business Process Optimization. We empower finance and healthcare organizations to thrive in a digital-first world by combining specialized industry expertise and innovative technology for 20 years.
We navigate complex industry landscapes to drive transformative outcomes, helping businesses streamline operations, enhance customer experience, and achieve sustainable growth backed by a world-class Net Promoter Score of 75. Our approach combines operational efficiency with a human-centered ethos, ensuring sustainable value creation for our clients and team members.

As a Certified B Corporation, Infinit-O is committed to the highest standards of social and environmental performance, accountability, and transparency. We embed these values into every aspect of our operations—aligning business success with a positive impact on our clients, people, and communities.
Our commitment to Diversity, Equity, and Inclusion (DEI) is integral to our mission. We believe that building inclusive, equitable teams is not only the right thing to do—it is also essential for driving innovation and better business outcomes. We actively promote equal opportunity through inclusive hiring practices, continuous learning programs, and regular equity assessments to ensure a fair and empowering workplace for all.

Summary

The Accounts Receivable (A/R) Specialist is a critical role responsible for actively managing the collection of outstanding claims and resolving all payment denials. This position directly impacts the client’s cash flow and revenue realization by ensuring all legitimate claims are paid quickly and accurately.

Key Responsibilities

• A/R Follow-Up:Systematically review and follow up on outstanding insurance claims that have aged beyond standard payment cycles, prioritizing accounts based on value and age.

• Denial Analysis & Resolution:Analyze Explanation of Benefits (EOB), Remittance Advices (RA), and denial codes to determine the root cause of non-payment.

• Appeals Management:Prepare and submit well-researched, customized appeals to payers for denied claims (e.g., medical necessity, lack of authorization, timely filing) using appropriate supporting clinical documentation and payer-specific guidelines.

• Payer Communication:Proactively contact insurance companies (via phone, website portals, or written correspondence) to check claim status, challenge underpayments, and negotiate resolution for complex A/R issues.

• Underpayment Review:Identify and investigate claims paid incorrectly or below contracted rates, initiating the necessary steps to recover the difference.

• Trend Identification:Document and escalate denial trends, coding issues, or payer process changes to management and the billing team to facilitate process improvement and prevention of future denials.

Reporting:Maintain detailed documentation of all follow-up and denial resolution steps in the billing system notes. Generate A/R performance reports as required.

Requirements

Job Requirements and Credentials:

• Education: High School Diploma or equivalent required. Associate’s or Bachelor’s degree in a relevant field preferred.

• Experience: Minimum 2-3 years of dedicated experience in Accounts Receivable follow-up and denial management within US Healthcare RCM.

• Technical Skills: Advanced proficiency in RCM/Practice Management Systems. Expert use of payer portals (e.g., Availity, Navinet) for claims status and eligibility. Strong knowledge of EOBs, RAs, and standard denial/adjustment codes.

• Excellent critical thinking and analytical skills to interpret complex denial reasons.

• Strong written and verbal communication skills for effective payer negotiations and professional appeals drafting.

• Results-oriented and highly persistent in follow-up.

• Other Proven ability to meet strict A/R aging and collection targets. Thorough understanding of the insurance appeals process across major payer types.

Details

Originally posted on Himalayas