Short answer: An accounts receivable (A/R) specialist follows up on unpaid and underpaid insurance claims until they're paid, corrected, appealed or properly written off. The job is checking claim status, calling payers, fixing errors, documenting every action and escalating patterns. You need one, or more hours from one, when claims are aging past 60 to 90 days and nobody has time to work them.
Claims don't pay themselves. Some are lost, some are pended for information, some are underpaid and some are denied without anyone noticing. The A/R specialist is the person who finds them and pushes them to resolution. It's part of our revenue cycle management staffing series.
A typical day
- Work the queue. Pull unpaid claims from the aging report, prioritized by dollar value and age, not alphabetically.
- Check status. Use payer portals and clearinghouse reports first, and call when the portal doesn't answer the question.
- Fix and resubmit. Correct demographic, coding or coordination-of-benefits errors, and send corrected claims.
- Escalate denials. Route denials to appeal or correction with the deadline noted (see denial management basics).
- Spot underpayments. Compare payments with contracted rates and flag shortfalls.
- Document everything. Every touch gets a note: what was done, who was contacted, the reference number and the next follow-up date.
Why the role matters
Unworked A/R gets harder to collect over time, and every payer has filing and appeal limits. For Medicare, the claim filing limit is one calendar year from the date of service (CMS Claims Processing Manual, Ch. 1, §70). Commercial payers often set shorter limits in their contracts. In a 2025 vendor survey of billing professionals, 26% named timely filing as a common denial reason (Tebra).
Denied claims also tend to stay denied when nobody follows up. KFF found consumers appealed fewer than 1% of denied in-network claims on HealthCare.gov plans in 2023 (KFF). That's patient-side data, but the lesson carries over: denials that no one works go unpaid.
Skills to hire for
- Reading ERAs and EOBs, including CARC and RARC codes
- Payer portal navigation and efficient payer calls
- Knowledge of timely filing, corrected-claim and appeal rules for your main payers
- Your practice management system and clearinghouse
- Persistence, organization and clear notes
- Judgment about when to escalate (write-offs and refunds need approval)
How to measure an AR specialist
Use measures you can see in your system:
- Days in A/R and the share of A/R over 90 days (see how to reduce A/R days)
- Claims touched per day, with notes and next-action dates
- Dollars resolved: paid, corrected or appealed
- Aged A/R trend by payer
- Quality: a sample of notes and actions reviewed each month
Avoid judging the role on claims touched alone. A day spent resolving one large, complicated claim can be worth more than 50 quick status checks.
When to add an AR specialist
Signs you need more A/R capacity:
- A/R over 90 days is growing month over month.
- Claims are hitting timely filing limits.
- Your biller does A/R "when there's time," which is never.
- Denials sit unworked for weeks.
- You can't say what happened to a specific unpaid claim.
In-house, outsourced or remote?
A/R follow-up is well suited to remote work because it happens in portals, on the phone and in your practice management system. Options include an in-house hire, a billing company that takes over A/R (often for a percentage of collections), or a dedicated remote specialist who works your queue in your systems. The staffing cost guide compares them. Whatever you choose, sign a BAA and set up role-based access first.
This site is operated by Alliance Global Solutions, which provides remote staff. You can read about its remote medical billing staff or its remote accounting staff. For a second opinion on your A/R workload, request a free staffing assessment.
Approved vendor: Alliance Global Solutions, which operates this site, provides dedicated remote staff for this work and signs a business associate agreement with each client before any PHI access. See approved vendors and how we vet vendors.
Technology
A/R specialists now use automated claim-status checks and work-queue prioritization to decide which claims to chase first. AI assistants can summarize payer call notes and draft appeal letters for the specialist to review before sending. Alliance Global Solutions helps clients set up AI assistant workflows alongside their dedicated staff.
FAQ
What is the difference between a medical biller and an AR specialist?
In smaller practices one person often does both. Billing focuses on getting clean claims out the door; A/R follow-up focuses on claims that were sent but not paid in full.
How many claims should an AR specialist work per day?
It depends on claim complexity, payer mix and how much is done by portal versus phone. Set expectations after a few weeks of real data, and measure dollars resolved as well as claims touched.
Can A/R follow-up be done remotely?
Yes. It happens in payer portals, by phone and in your practice management system. Remote staff need a BAA, secure access, and role-based permissions.
What is the Medicare timely filing limit?
CMS sets it at one calendar year from the date of service. Commercial payer limits vary by contract and are often shorter.
What KPIs should I track for A/R?
Days in A/R, the percentage of A/R over 90 days, dollars resolved, aged A/R by payer, and a quality review of documented actions.