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Out of Network A/R Rep

Posted: July 10, 2024
Salary:US$22 - US$35 per hour
Location:New Hyde Park
Job type: Contract
Discipline:Revenue Cycle
Work Location:On-site

Job description

Position Overview: We are seeking a detail-oriented and experienced Out of Network Accounts Receivable (A/R) Representative to join our healthcare finance team. The ideal candidate will be responsible for managing and resolving out-of-network insurance claims and ensuring timely and accurate reimbursement. This role requires a strong understanding of medical billing, coding, and insurance procedures, along with excellent analytical and communication skills.

Key Responsibilities:

  • Claims Management:

    • Review, submit, and follow up on out-of-network insurance claims to ensure timely payment.
    • Investigate and resolve claim denials and discrepancies by working with insurance companies, patients, and internal departments.
    • Appeal denied or underpaid claims by providing necessary documentation and evidence.
  • Account Reconciliation:

    • Reconcile payments and adjustments, ensuring accuracy in patient accounts and financial records.
    • Monitor accounts receivable aging reports and take proactive measures to collect outstanding balances.
    • Perform audits on patient accounts to identify and rectify errors.
  • Communication:

    • Communicate with insurance companies to verify coverage, obtain authorizations, and clarify payment policies.
    • Serve as a point of contact for patients regarding billing inquiries, providing clear and accurate information.
    • Collaborate with internal departments, including billing, coding, and patient services, to streamline processes and improve reimbursement rates.
  • Documentation and Reporting:

    • Maintain accurate and detailed records of all claims, payments, and communications with insurance companies.
    • Generate regular reports on account statuses, collection activities, and financial performance metrics.
    • Ensure compliance with federal, state, and payer-specific billing regulations and guidelines.


  • High school diploma or equivalent; associate's degree in healthcare administration, finance, or related field preferred.
  • Minimum of 2 years of experience in medical billing and accounts receivable, specifically with out-of-network claims.
  • Strong knowledge of medical terminology, billing codes (CPT, ICD-10), and insurance procedures.
  • Proficiency in using billing software and electronic health records (EHR) systems.
  • Excellent analytical, problem-solving, and organizational skills.
  • Strong verbal and written communication skills.
  • Ability to work independently and as part of a team in a fast-paced environment.
Must Have Skills/Qualifications
  • Billing system - sequelmed - can train on that system, would be a plus.
  • Someone who has worked 3rd party strictly out of network, or someone in a billing roles within an office/system.
  • Physician billing experience.
  • Out of network experience is strongly preffered.
  • Commercial payers.
  • Reviewing claims.
  • Working appeals.
  • Working denials.
  • EOBs.
  • CPT/ICD.
Schedule/Shift: Monday-Friday 9AM-5PM