Accounts Receivable & Case Management Specialist

Under the direction of the Associate Director or Manager of Revenue Cycle
Management, the Accounts Receivable (AR) Case Management Specialist is
responsible for ensuring the accurate and timely processing of all claims concerns or
claim projects. This role acts as a bridge between financial accuracy and efficient
communication, promptly addressing daily correspondence from physicians, care
centers, vendors, and internal teams to resolve insurance claim denials. By leveraging
Salesforce case management workflows, the AR Manager ensures that all claim issues
or questions escalating to the RCM team are tracked, managed, and resolved with
accountability.

Primary Job Duties
● Manage the full cycle of Salesforce cases, ensuring all RCM-related inquiries are
documented, categorized, and resolved within established Service Level
Agreements (SLAs).
● Monitor Salesforce dashboards to identify practice inquiries trends and report on
case resolution efficiency to leadership.
● Deep expertise in billing, AR follow up, and denial management to promote one
touch resolution of escalated cases.
● Make independent decisions regarding claim adjustments, resubmissions, and
other advanced resolution techniques in accordance with company policies and
best practices.
● Collaborate with internal teams and care center staff to streamline workflows and
resolve escalated billing hurdles.
● Utilize the Trizetto to perform denial analysis and initiate requests to add rules or
edits to prevent recurring errors.
● Work directly with practice consultants or physicians to ensure optimal revenue
cycle functionality and drive department Key Performance Indicators (KPIs).
● Other duties as assigned.