Medicare/Medicaid AR Specialist

Job Title: Medicare/Medicaid Accounts Receivable (AR) Specialist

Job Summary:

The Medicare/Medicaid AR Specialist is responsible for managing the accounts receivable process specifically for Medicare, Medicaid, and dual-eligible patients. This role ensures timely and accurate claim follow-up, and resolution of denials or underpayments. The specialist works closely with clinical, coding, and billing teams to maximize reimbursement, maintain compliance with federal and state regulations, and support the financial health of Heaton Eye Associates.

Key Responsibilities:

Claims & Reimbursement Management

• Submit, track, and follow up on Medicare, Medicaid, and dual-eligible claims.

• Review claim denials and rejections, identify errors, and resubmit claims in accordance with payer requirements.

• Appeal underpaid or denied claims to ensure maximum reimbursement.

Patient Billing & Communication

• Address patient inquiries related to Medicare/Medicaid coverage or payments.

Reporting & Compliance

• Maintain AR aging reports and monitor collection performance for government payers.

• Ensure compliance with HIPAA, federal/state regulations, and payer-specific requirements.

Collaboration & Process Improvement

• Work with coders, front desk, and clinical staff to ensure proper documentation and accurate billing.

• Assist with audits, credentialing, and payer-specific requirements.

• Identify process inefficiencies and recommend improvements to reduce AR cycle times.

Qualifications:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.

• Minimum 2 years of experience in medical billing, with a focus on Medicare/Medicaid preferred.

• Knowledge of CPT, HCPCS, ICD-10 coding, and AR processes in ophthalmology or specialty clinics preferred.

• Strong attention to detail, organizational skills, and ability to manage multiple accounts.

• Proficiency with practice management software and Microsoft Office Suite.