AR Specialist 2- Complex Clinical Denials

Overview

This role involves supporting healthcare organizations by managing medical insurance accounts receivable to ensure timely collection of outstanding government or commercial healthcare insurance payments. The position focuses on revenue cycle improvement services that help control costs, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.

Responsibilities

• Verify and obtain eligibility and/or authorization using payer websites, client eligibility systems, or direct communication with insurance carriers/providers
• Update patient demographics and insurance information in relevant systems
• Research and monitor unpaid or denied claims
• Check claims for missing information, authorizations, and control numbers (ICN/DCN)
• Review Explanation of Benefits (EOBs) for payments or adjustments to resolve claims
• Contact payers via phone or written correspondence to secure payment, including reconsideration and appeal submissions
• Adhere to state and federal claim and appeal guidelines
• Access client systems for payment, patient, claim, and data information
• Follow prioritization, timely filing deadlines, and notation protocols within appropriate systems
• Secure necessary medical documentation requested by third-party insurance carriers
• Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policies
• Meet productivity and performance expectations
• Perform other related duties as required

Minimum Requirements & Competencies

• 2-3 years of experience in medical collections, denials, and appeals
• Experience handling denials and appeals including DRG downgrades, level of care, coding, medical necessity, experimental treatments, bundling, noncovered services, and lack of authorization
• Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI coding systems
• Intermediate knowledge of third-party billing guidelines
• Intermediate knowledge of billing claim forms (UB04/1500)
• Intermediate knowledge of commercial and government payor contracts
• Intermediate proficiency with Microsoft Word and Excel
• Intermediate knowledge of health information systems such as EMR, claim scrubbers, and patient accounting systems

Preferred Qualifications

• Intermediate knowledge of one or more patient accounting systems such as EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
• Intermediate knowledge of DDE Medicare claim system
• Intermediate knowledge of government rules and regulations

Compensation & Benefits

• Salary range: $20.00 to $23.00 per hour
• Actual compensation will vary based on geographic location, candidate experience, certifications, and skills

Equal Opportunity Statement

The employer is an Equal Opportunity Employer and does not discriminate based on race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other protected class under federal, state, or local law.