Accounts Receivable Reconciliation Specialist

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Accounts Receivable Reconciliation Specialist - Home Care and Medicaid

Rate:

Php 267.85 per hour

Work Type:

• Remote/WFH
• Full-time

Working Hours:

TBD (Usually US Hours/Night shift)

Start Date:

TBD

JOB OVERVIEW:

The Accounts Receivable Reconciliation Specialist is responsible for managing and resolving outstanding Medicaid accounts receivable for U.S. home care services. The role ensures that authorized, scheduled, delivered, EVV-verified, billed and paid service units reconcile accurately.

This position requires direct experience with home care Medicaid billing and post-submission claims management. The specialist must be able to investigate denials, underpayments and payment discrepancies with minimal training and follow each claim through final resolution.

JOB ROLE & RESPONSIBILITIES:

Duties and Responsibilities

• Review accounts receivable aging reports and prioritize denied, rejected, unpaid, partially paid and underpaid claims.
• Reconcile authorized, scheduled, worked, EVV-verified, billed and paid service units.
• Compare expected reimbursement with actual payments and adjustments received.
• Review ERA, EOB and 835 remittance information to identify denial and adjustment reasons.
• Interpret Claim Adjustment Reason Codes and Remittance Advice Remark Codes.
• Investigate discrepancies involving authorizations, service dates, billing codes, modifiers, units, reimbursement rates and payer requirements.
• Identify and help resolve EVV exceptions, including missing or incorrect visit times, service details, caregiver information and client information.
• Correct and resubmit claims and prepare reconsiderations or appeals when required.
• Follow up with Medicaid programs, managed care organizations and other payers through portals, telephone calls and secure communication channels.
• Research claim status and maintain complete documentation of follow-up activity, payer responses and required next steps.
• Reconcile payments, contractual adjustments, credit balances and unapplied or incorrectly posted payments.
• Coordinate with billing, payment posting and operations teams to correct upstream issues affecting reimbursement.
• Maintain accurate account notes and supporting documentation for audit and compliance purposes.
• Prepare reports on AR aging, denials, underpayments, recovery activity and unresolved balances.
• Identify recurring denial patterns and recommend process improvements to prevent future billing issues.
• Handle protected health information in accordance with HIPAA requirements and established security procedures.
• Complete assigned accounts accurately and within agreed productivity and turnaround-time expectations.

JOB REQUIREMENTS:

• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, Nursing, or another relevant field.
• At least two to three years of hands-on experience in U.S. healthcare billing, accounts receivable or revenue cycle management.
• Direct experience handling Medicaid claims and accounts receivable for home care, personal care services or home and community-based services.
• Proven experience managing claims after submission, including denials, rejections, underpayments, corrected claims, appeals and payer follow-up.
• Experience working with Medicaid managed care organizations, state Medicaid programs or Medicaid payer portals.
• Working knowledge of EVV requirements and their effect on home care claim acceptance and reimbursement.
• Experience reconciling authorizations, visits, service units, claims, remittances and payments.
• Strong understanding of ERA, EOB, 835, CARC and RARC information.
• Experience using home care management platforms, EVV systems, clearinghouses, electronic payer portals and healthcare billing systems.
• Strong Microsoft Excel skills, including filters, lookups, pivot tables and reconciliation of large datasets.
• Understanding of accounts receivable controls, basic accounting principles and GAAP-aligned recordkeeping.
• Ability to investigate discrepancies independently and follow claims through final resolution.
• Strong analytical, organizational and problem-solving skills.
• Excellent English communication skills, both written and verbal, with exceptional comprehension.
• High level of accuracy and attention to detail.

Preferred Certifications:

• Certified Professional Biller (CPB) from AAPC
• Certified Revenue Cycle Representative (CRCR) from HFMA
• Certified