Accounts Receivable Representative (Administrative)

Title: Accounts Receivable Representative
Reports to: Director, Patient Financial Services
Classification: Individual Contributor
Location: Boston (Hybrid)
Job description revision number and date: V2.0; 4.24.25

OrganizationSummary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) 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 are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country. We are an innovative 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 Representative 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), Epic systems, and expertise in charge router and claim form logic. 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 claims workflows
Identify and resolve charge capture errors or discrepancies to prevent billing delays
Prepare and submit clean claims to insurance payers, ensuring adherence to payer-specific requirements
Apply claim form logic to review and resolve formatting errors before submission
Monitor claims for timely submission and work closely with follow-up teams to address rejected or denied claims
Reconcile daily charge and payment batches to ensure accuracy in billing and payment applications
Work with clearinghouses and payer portals to track claim status and resolve outstanding issues
Assist in managing accounts receivable by identifying trends in denials or delays
Leverage Epic systems and other EHRs to support billing workflows, payment posting, and reporting

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, payer policies, and industry best practices
Participate in internal and external audits as required
Partner with clinical, coding, and accounts receivable teams to resolve billing and documentation issues
Communicate effectively with insurance companies, patients, and other stakeholders to address billing inquiries
Provide support and guidance to junior billing staff as needed
Generate and review billing reports to monitor performance metrics, identify trends, and support decision-making
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 systems, including charge router and claims workflows
Strong understanding of claim form logic and payer-specific billing requirements
Familiarity with Massachusetts healthcare regulations and insurance processes
Experience with EHRs and related software packages
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 C3s mission

Desired Other Skills:

Epic experience preferred
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; Associates or Bachelors degree in business, healthcare administration, or a related field is preferred

**In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **