Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals.
Full Cycle Accounts Receivable Management
- Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution.
- Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers.
- Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable.
Denial & Claim Resolution
- Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions.
- Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines.
- Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements.
- Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers.
Payer & Client Communication
- Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues.
- Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts.
- Build strong relationships with payer representatives to improve overall reimbursement efficiency.
Regulatory & Systems Expertise
- Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines.
- Review and resolve EDI rejections, claim edits, and submission errors.
- Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity.
- Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.
Required Qualifications
- High school diploma or GED.
- Minimum 1 year of medical billing, claims, or A/R experience.
- Advanced Microsoft Excel skills (vlookups, pivot tables, data organization).
- Strong analytical, investigative, and problem-solving skills.
- Excellent verbal and written communication skills.
- Demonstrated ability to work independently, meet deadlines, and achieve productivity goals.
- Basic understanding of insurance plans, medical terminology, Medicare and Medicaid billing guidelines.
Preferred Qualifications
- Experience in behavioral health, home care, long-term care, or similar clinical billing environments.
- Prior healthcare collections or reimbursement experience.
- Experience with medical billing platforms such as Medic, IDX, Avatar, Tier, Medical Manager, or similar systems.
- Exposure to or interest in automation, AI-supported workstreams, or RPA technologies used in revenue cycle operations.
Work Environment & Expectations
- Comfortable working in a remote environment using virtual communication and collaboration tools.
- Ability to perform job functions involving extended periods of computer and phone use.
- Commitment to accuracy, efficiency, and continuous improvement in revenue cycle operations.
Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.
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NetSmart Technologies
Feb 13, 2026