Accounts Receivable, Denial Management Specialist

About the Role

RCM Staff LLC is hiring a remote Accounts Receivable and Denial Management Specialist in the Philippines to assist U.S. healthcare providers. This role involves performing critical revenue cycle functions, including managing claims within EHR systems, clearinghouses, and payer portals. Successful candidates will work in a supportive environment that adheres to U.S. healthcare standards, contributing directly to the financial success of medical practices and vendors across the United States. The position requires a focus on professional compliance, precise medical reimbursement management, and effective communication with client teams.

Requirements

• The ideal candidate will possess at least 3 years of U.S. medical billing experience, with a specific focus on A/R follow-up and denial management.
• Hands-on proficiency in working within the athenaOne EHR platform is required, along with proven experience preparing and submitting formal appeals and reconsiderations.
• You must have a strong working knowledge of commercial insurance, Medicare, and Medicaid plans.
• Excellent communication skills in both written and spoken English are essential, as you will be responsible for contacting insurance companies and engaging in regular meetings with client teams.
• You should be capable of working independently to manage high-volume account work, demonstrating exceptional attention to detail.
• Candidates must be available to work hours that overlap with U.S.
• Eastern Time business hours and possess a reliable internet connection with a suitable remote workspace.
• Previous experience supporting multi-specialty practices, particularly in fields like cardiology, orthopedics, or behavioral health, is highly preferred.

Responsibilities

• In this role, you will manage a daily worklist within the athenaOne system, prioritizing claims based on aging, balance, and upcoming filing deadlines.
• Your duties include conducting follow-ups with payers via phone calls and web portals to resolve unpaid or underpaid claims.
• You will be expected to review denials to identify root causes and perform the necessary corrections to facilitate successful claim resubmission.
• Furthermore, you will manage the lifecycle of reconsiderations and appeals, tracking each through to a final decision.
• Maintaining accurate documentation is a critical aspect of this position, as you must record status updates, reference numbers, and next steps for every account.
• You will also monitor timely filing deadlines, route coding or provider enrollment issues to the appropriate internal teams, and provide a comprehensive end-of-shift summary of your work.
• Throughout all these activities, you will be required to strictly uphold HIPAA compliance to ensure the protection of patient information.

Benefits & Perks

• The position is a full-time remote role that features a consistent night-shift schedule aligned with U.S.
• Eastern Time business hours.
• You will benefit from a structured environment that includes regular scheduled meetings and real-time communication with client teams.
• Additionally, the role provides the professional opportunity to work across diverse medical specialties, supporting physician practices nationwide.