Revenue Cycle Management (RCM) Aging Specialist
Agendia Inc, Irvine, CA, United States
Job Summary
The RCM Aging Specialist is responsible for following up on aged accounts by working with insurance A/R aging reports (60/90/120+ days) to identify unpaid or underpaid claims and ensure timely, accurate reimbursement from insurance companies. This role requires strong payer communication skills, effective time management, attention to detail, and a working knowledge of reimbursement guidelines, appeals processes, and compliance regulations.
Position
Reports to Reimbursement Supervisor
Cooperates with all departments across the organization
Organizes activities with Customer Care, Sales, Commercial and external vendors
Participates in department meetings, project meetings, working groups and project groups
Essential Duties and Responsibilities
Collects payments due from insurance companies, hospitals, and patients in compliance with CLIA, OIG, and all applicable federal and state regulations.
Performs follow‑up with insurance carriers on claims and appeals when no payment or correspondence has been received within required timeframes.
Follows up with insurance companies via portals, phone calls, and emails to resolve claim status.
Contacts clients, physician offices, and facilities to obtain medical records required for claim reviews, audits, or appeals.
Prepares appeal letters and letters of interest for submission to insurance carriers and managed care organizations.
Reviews patient balances and determines insurance versus patient responsibility.
Coordinates with patient billing team when balances roll over to self‑pay.
Reviews account files to determine appropriate write‑offs based on allowable reimbursement guidelines and submits recommendations to the Reimbursement Supervisor.
Investigates and prepares refund requests from payers and submits documentation to the Reimbursement Director.
Negotiates single‑claim settlements with insurance carriers and third‑party administrators in accordance with department policies.
Interfaces with insurance representatives, physician offices, and hospitals regarding billing inquiries and service schedules.
Provides account status and reimbursement data to the sales team as needed.
Identifies trends in denials or delays and reports them to leadership or coding/billing teams.
Education and Experience Requirements
Education:
High school diploma or general education degree.
Minimum of 1 year experience in medical billing, accounts receivable, or revenue cycle management (aging and follow‑up required).
Strong knowledge of EOBs, denial codes, and payer‑specific reimbursement rules.
Strong knowledge of insurance claims processing, appeals, reimbursement methodologies, and payer guidelines.
Familiarity with compliance standards including CLIA, OIG, HIPAA, and other applicable regulations.
Excellent written and verbal communication skills, including professional payer and patient interaction.
Ability to negotiate reimbursement effectively and document outcomes accurately.
Strong analytical, organizational, and time‑management skills.
Proficiency with billing systems, clearinghouses, and Microsoft Office applications.
Preferred Qualifications
Experience working with hospital, laboratory, or physician billing environments.
Prior experience handling insurance appeals and payer negotiations.
Experience with XIFIN billing and revenue cycle management systems.
Working knowledge of Salesforce (Sales Force) CRM, including account tracking and reporting.
Competencies and Desired Skills
Excellent problem resolution.
Excellent customer service skills.
Outside‑the‑box thinker.
Benefits and Conditions
No travel is required.
Other duties as required by management.
Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.
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The RCM Aging Specialist is responsible for following up on aged accounts by working with insurance A/R aging reports (60/90/120+ days) to identify unpaid or underpaid claims and ensure timely, accurate reimbursement from insurance companies. This role requires strong payer communication skills, effective time management, attention to detail, and a working knowledge of reimbursement guidelines, appeals processes, and compliance regulations.
Position
Reports to Reimbursement Supervisor
Cooperates with all departments across the organization
Organizes activities with Customer Care, Sales, Commercial and external vendors
Participates in department meetings, project meetings, working groups and project groups
Essential Duties and Responsibilities
Collects payments due from insurance companies, hospitals, and patients in compliance with CLIA, OIG, and all applicable federal and state regulations.
Performs follow‑up with insurance carriers on claims and appeals when no payment or correspondence has been received within required timeframes.
Follows up with insurance companies via portals, phone calls, and emails to resolve claim status.
Contacts clients, physician offices, and facilities to obtain medical records required for claim reviews, audits, or appeals.
Prepares appeal letters and letters of interest for submission to insurance carriers and managed care organizations.
Reviews patient balances and determines insurance versus patient responsibility.
Coordinates with patient billing team when balances roll over to self‑pay.
Reviews account files to determine appropriate write‑offs based on allowable reimbursement guidelines and submits recommendations to the Reimbursement Supervisor.
Investigates and prepares refund requests from payers and submits documentation to the Reimbursement Director.
Negotiates single‑claim settlements with insurance carriers and third‑party administrators in accordance with department policies.
Interfaces with insurance representatives, physician offices, and hospitals regarding billing inquiries and service schedules.
Provides account status and reimbursement data to the sales team as needed.
Identifies trends in denials or delays and reports them to leadership or coding/billing teams.
Education and Experience Requirements
Education:
High school diploma or general education degree.
Minimum of 1 year experience in medical billing, accounts receivable, or revenue cycle management (aging and follow‑up required).
Strong knowledge of EOBs, denial codes, and payer‑specific reimbursement rules.
Strong knowledge of insurance claims processing, appeals, reimbursement methodologies, and payer guidelines.
Familiarity with compliance standards including CLIA, OIG, HIPAA, and other applicable regulations.
Excellent written and verbal communication skills, including professional payer and patient interaction.
Ability to negotiate reimbursement effectively and document outcomes accurately.
Strong analytical, organizational, and time‑management skills.
Proficiency with billing systems, clearinghouses, and Microsoft Office applications.
Preferred Qualifications
Experience working with hospital, laboratory, or physician billing environments.
Prior experience handling insurance appeals and payer negotiations.
Experience with XIFIN billing and revenue cycle management systems.
Working knowledge of Salesforce (Sales Force) CRM, including account tracking and reporting.
Competencies and Desired Skills
Excellent problem resolution.
Excellent customer service skills.
Outside‑the‑box thinker.
Benefits and Conditions
No travel is required.
Other duties as required by management.
Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.
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