Accounts Receivable Reconciliation Specialist

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Job Title: 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 Billing and Coding Specialist (CBCS) from NHA
• Certified Professional Coder (CPC) from AAPC