Accounts Receivable (A/R) and Denial Management Specialist (athenahealth)

The specialist will work claims and denials daily inathenaOneacross specialties such as cardiology, orthopedics, podiatry, retina, family medicine, OB/GYN and behavioral health. This role requires solid A/R and denial experience, such as strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.

Key Responsibilities

• Work a daily worklist in athenaOne, starting with new denials and payer correspondence, then open A/R prioritized by filing deadline, age and balance
• Follow up with payers on unpaid and underpaid claims through payer portals and phone calls
• Document claim status, call reference numbers and next steps on every account worked
• Review denials, identify the root cause, and correct and resubmit claims
• Prepare and submit reconsiderations and appeals, and track them through to a decision
• Monitor timely filing and appeal deadlines so claims do not age out
• Route coding, authorization and provider enrollment issues to the right team for resolution
• Join scheduled meetings with the client team and send a daily end-of-shift summary of completed work and open items
• Protect patient information and follow HIPAA requirements

Qualifications

• At least 3 years of U.S. medical billing experience, focused on A/R follow-up and denial management
• Hands-on experience working claims and denials in athenahealth (athenaOne)
• Experience preparing and submitting appeals and reconsiderations
• Familiarity with commercial insurance and government health plans, such as Medicare and Medicaid
• Comfortable calling insurance companies and using payer portals for claim follow-up
• Strong written and spoken English
• Excellent attention to detail and follow-up skills
• Ability to work independently and manage a high volume of accounts
• Reliable internet connection and a suitable remote workspace

Preferred Qualifications

• Experience working for a U.S. medical billing company that supports multiple client practices
• Multi-specialty billing experience, especially cardiology, orthopedics, podiatry, ophthalmology/retina, OB/GYN or behavioral health
• Familiarity with Ohio payers, including Ohio Medicaid managed care plans
• Experience with Medicare Advantage plans and aged A/R cleanup projects

Schedule

• Full-time position
• Must be available for hours that overlap U.S. Eastern Time business hours (night shift, Philippine time) for meetings, real-time communication and payer calls
• Final schedule will be determined based on client needs

Work Arrangement

• Remote
• Philippines-based applicants preferred