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Complex Accounts Receivable Resolution Specialist - Earth City, MO

Location: Earth City, MO 63045 (Hybrid - 1 day per week from home)

Schedule: Monday - Friday, 8:00 AM - 5:00 PM CST (Flexible)

Training: 2 weeks, Monday - Friday, 8:00 AM - 5:00 PM CST

Start Date: asap

Experience: 5+ years in healthcare revenue cycle

Job Summary

The Complex Accounts Receivable Resolution Specialist is responsible for independently investigating and resolving high-complexity physician accounts receivable that are considered difficult to resolve through standard follow-up processes. This role requires advanced revenue cycle knowledge, strong analytical judgment, and the ability to research payer requirements, interpret reimbursement data, identify root causes, and pursue the appropriate resolution strategy through final account disposition. The position supports Cognizant's commitment to operational excellence, financial recovery, client satisfaction, compliance, and continuous process improvement.

Role Purpose

This position serves as a senior-level contributor responsible for resolving complex, aged, denied, underpaid, or otherwise challenging AR inventory. The specialist is expected to apply independent critical thinking, validate prior account activity, determine whether additional reimbursement opportunity exists, and take the appropriate actions to support timely and accurate revenue recovery for Cognizant clients.

Key Responsibilities

- Manage and resolve complex physician AR inventory, including aged accounts, denials, underpayments, payment variances, reimbursement discrepancies, and claims requiring advanced follow-up.

- Follow up directly with insurance companies to resolve outstanding claims, denials, underpayments, and payment variances.

- Prepare, submit, and follow through on technical and clinical appeals.

- Independently navigate payer portals to research claims, obtain payment information, upload documentation, and complete payer-specific requirements.

- Accurately document all payer contacts, reference numbers, findings, actions taken, and next steps.

- Prioritize outstanding AR based on aging, financial impact, denial type, payer requirements, and recovery opportunity.

- Identify root causes of denials, underpayments, and payment delays and determine appropriate corrective action.

- Resolve accounts efficiently with a focus on maximizing reimbursement and minimizing unnecessary touches.

- Track and trend claim denials and underpayments to identify payer, process, technology, and workflow improvement opportunities.

- Identify trends across payers, providers, Tax IDs, CPTs, modifiers, denial codes, reason codes, and reimbursement outcomes.

- Communicate findings, financial impact, and recommendations to leadership.

- Make recommendations for additions, revisions, or deletions to work queues, claim edits, workflows, and processes to improve efficiency and reduce denials.

- Serve as a resource for complex AR scenarios by applying independent research, sound judgment, and payer-specific knowledge to determine the best course of action.

- Support Cognizant leadership by escalating confirmed systemic issues, payer barriers, workflow gaps, and financial risk items with clear documentation and recommended next steps.

Qualifications

- 5+ years of healthcare revenue cycle experience, preferably in physician AR, collections, or denial management.

- Strong working knowledge of the healthcare revenue cycle.

- Strong knowledge of medical terminology, CPT/HCPCS codes, modifiers, diagnosis codes, NCCI edits, reimbursement methodologies, and payer-specific requirements.

- Strong knowledge of state and federal billing guidelines, payer policies, reimbursement methodologies, and claim adjudication requirements.

- Demonstrated ability to interpret and apply payer policies, provider manuals, medical policies, and reimbursement guidelines to resolve complex denials and underpayments.

- Ability to independently research payer guidelines and determine the appropriate resolution strategy without relying on management direction.

- Demonstrated ability to identify the root cause of claim issues, develop a resolution strategy, and follow accounts through final resolution with minimal supervision.

- Demonstrated critical-thinking skills with the ability to challenge assumptions, research discrepancies, validate findings, and apply a trust-but-verify approach before escalating issues.

- Demonstrated ability to independently investigate denials and validate prior account activity before determining that no additional reimbursement opportunities exist.

- Experience researching and resolving complex denials and underpayments.

- Experience writing and submitting appeals.

- Experience utilizing payer portals and clearinghouse systems.

- Experience utilizing EOBs/ERAs, 835s, and 837 claim data to drive account resolution.

- Strong analytical skills with the ability to distinguish between isolated account issues and broader systemic trends.

- Strong Excel skills with the ability to organize, analyze, summarize, and trend AR data.

- Strong written and verbal communication skills.

- Demonstrated initiative, resourcefulness, accountability, and ownership of assigned work.

- Ability to consistently meet productivity, quality, and financial recovery goals.

Core Competencies

- Advanced problem-solving and investigative research skills.

- Strong ownership, accountability, and ability to work independently with minimal supervision.

- Ability to distinguish between account-level issues and broader payer, process, or system trends.

- Professional communication skills with the ability to clearly present findings, risks, and recommendations.

Requirements

- High School Diploma (minimum)

- Associate's or Bachelor's degree in Healthcare Administration, Business, Finance, Health Information Management, or related field, or equivalent experience (Preferred)

- 5+ years of related healthcare revenue cycle experience

- Experience with Athena EHR, practice management, and AR systems.

- Experience with denial trending, root cause analysis, and process improvement.

- Experience with commercial, Medicare, Medicaid, and managed-care payers.

Preferred Qualifications

- Associate or Bachelor's degree in Healthcare Administration, Business, Finance, Health Information Management, or related field, or equivalent experience.

- Experience developing reports and presenting findings to leadership.

Compensation

The annual salary for this position is up to $70,000.00 depending on experience and other qualifications of the successful candidate.

Applications will be accepted until 11/6th

This position is also eligible for Cognizant's discretiona...

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