Accounts Receivable Specialist
Title: Accounts Receivable Specialist
Reports to: Director, Patient Financial Services
Classification: Individual Contributor
Location: Boston (Hybrid)
Job description revision number and date: V3.0; 9.9.25
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.
As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the MassHealth ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide.
As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.
We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
We are seeking an experienced Accounts Receivable Specialist to join our revenue cycle team. The
ideal candidate will have a strong background in professional billing or working in a doctor's office, with a preference for experience in Federally Qualified Health Centers (FQHC). The position requires a
detail-oriented and collaborative professional responsible for the implementation, configuration,
optimization, and support of Epic’s Resolute Professional Billing (PB) module. This role ensures accurate and efficient billing workflows, charge capture, claims processing, and reimbursement across the healthcare revenue cycle. Familiarity with Massachusetts healthcare regulations, electronic health records (EHRs), and related software is essential for success in this role.
Responsibilities:
- Enter and review charges for accuracy, ensuring proper coding and compliance with payer requirements
- Utilize the charge router within Epic to route charges efficiently and accurately to the correct claim workflows
- Identify and resolve charge capture errors or discrepancies to prevent billing delays
- Prepare, review, and submit electronic and paper claims through Epic and various clearinghouses, ensuring compliance with FQHC billing guidelines and Massachusetts-specific regulations
- Apply claim form logic to review and resolve formatting errors before submission
- Liaise with insurance companies to resolve discrepancies, missing files, and claim rejections
- Analyze claim form logic, including UB-04 and CMS-1500 formats, to ensure proper billing practices are followed
- Monitor claims for timely submissions by working closely with follow-up colleagues to address rejected or denied claims
- Assist in managing accounts receivable by identifying trends in denials or delays
- Perform payer appeals on denied claims as needed
- Leverage Epic systems and other EHRs to support billing workflows, payment posting, and reporting
- Reconcile daily payment batches to ensure all funds are accounted for and discrepancies are resolved promptly
- Monitor unapplied payments and resolve posting errors in a timely manner
- Work with banking institutions to ensure accurate deposit processing and address returned or rejected transactions
- Function as a point of contact for inquiries related to payment posting and ERA processes
- Generate and analyze payment posting and cash reconciliation reports to identify trends and areas for improvement
- Maintain and update patient accounts and payer information in the system as needed
- Collaborate with IT and billing teams to address system-related issues impacting billing processes
- Ensure billing practices comply with FQHC-specific guidelines, Massachusetts healthcare regulations, and payer rules
- Stay updated on changes to coding guidelines, billing codes, payer policies, and industry best practices
- Participate in internal and external audits as required
- Partner with clinical, coding, and health information teams to resolve billing documentation issues
- Communicate effectively with insurance companies, patients, and other stakeholders to address billing inquiries
- Review billing dashboards as a tool to monitor performance metrics and identify denial trends
- Provide feedback to leadership on areas for improvement within billing workflows
- Communicate effectively with insurance payers, patients, and internal teams to resolve billing and payment issues
- Provide excellent customer service when assisting with account inquiries or payment concerns.
- Other duties as assigned
Required Skills:
- Knowledgeable of Massachusetts healthcare billing regulations and payer requirements
- Minimum of 3-5 years of experience in medical billing, preferably in an FQHC or professional billing setting
- Proficiency in Epic resolute professional billing processes
- Strong understanding of claim form logic and payer-specific billing requirements
- Familiarity with Massachusetts healthcare regulations and insurance processes
- Knowledge of medical coding (CPT, ICD-10, HCPCS) and compliance requirements
- Excellent attention to detail, organizational skills, and the ability to meet deadlines
- Strong communication and problem-solving skills
- Solid communication skills across stakeholders, diligence, and problem-solving skills
- Experience in Microsoft Office Suite
- Must have a strong commitment to quality assurance and exceptional customer service.
- A strong commitment to C3’s mission
Desired Other Skills:
- Familiarity with the MassHealth ACO program
- Familiarity working in Federally Qualified Health Centers (FQHC)
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
- High school diploma or equivalent required; associate or bachelor’s degree in business, healthcare administration, or a related field is preferred
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