Accounts Receivable & Follow-Up Specialist

The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.   CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health equity in our organization.
Reporting directly to the Revenue Cycle Manager, Revenue Cycle AR and Follow-Up Specialist is responsible for managing the accounts receivable process within the revenue cycle. This role involves ensuring timely collection of payments, resolving claim denials, and maintaining accurate financial records. The specialist will work closely with insurance companies, patients, and internal departments to optimize revenue collection and ensure compliance with billing regulations.

Essential Functions

• Ability to perform all duties for a Billing Specialist
• Handle complex accounts for both follow-up, appeal, and credit balance resolution
• Follow up on unpaid claims to collect outstanding balances. Investigate and resolve claim denials by reviewing medical records, coding, and payer contracts
• Ability to write and submit escalated appeal letters and represent compelling case to overturn denials with payors, following all billing and compliance regulatory guidelines 
• Reviewing daily clearinghouse rejections, resolving, and alerting management of any trends in claim rejections
• Maintain detailed and accurate patient financial records, documenting all account notes and actions taken
• Work with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement
• Ability to follow-up on multiple payor types and across multiple states for Commercial, Medicare, 
• Medicaid, Medicaid Managed Care, Blue Cross, Title X, etc. 
• Review aged accounts, coordinates and escalates any denial and appeal projects with payors 
• Achieve established key performance indicators (KPIs) for position
• Communicate effectively with insurance companies, patients, and healthcare providers to resolve billing issues and ensure accurate claim submission
• Assist Manager to resolve issues and provide support and guidance to the revenue cycle team
• Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community