AR Specialist

Overview

A medical group specializing in advanced retinal treatments is seeking an AR Specialist to manage insurance accounts receivable. The role focuses on resolving billing discrepancies, ensuring compliance with payer requirements, and supporting accurate and timely reimbursement throughout the revenue cycle. The organization operates multiple locations in the Bay Area with over 40 years of experience.

Responsibilities

• Conduct thorough follow-up on patient accounts to maximize reimbursement, including monitoring assigned claim and AR worklists.
• Identify and resolve insurance-related issues affecting patient accounts, such as credit balances and payment discrepancies.
• Contact payers to pursue appeals, reconsiderations, adjustments, claim corrections, and documentation requests necessary for claim resolution.
• Monitor and resolve clearinghouse rejections to ensure timely and accurate claim transmission.
• Accurately bill secondary claims in accordance with payer requirements.
• Escalate unresolved payer issues through appropriate grievance protocols promptly.
• Collaborate with revenue cycle management (RCM) team members to resolve outstanding balances and support overall revenue cycle performance.
• Partner with RCM leadership to clarify billing and documentation policies, address ambiguous guidelines, and flag potential billing issues related to insurance carriers and payment resolution.
• Monitor, track, and report payer trends or systemic billing issues proactively to RCM leadership.
• Maintain working knowledge of payer-specific contracts, including timely filing requirements, contract rates, and reimbursement terms.
• Stay current on healthcare regulations, state-specific rules, and insurance plan requirements affecting billing and collections.
• Handle insurance correspondence professionally and according to departmental protocols.
• Meet or exceed department qualitative and quantitative performance targets.
• Perform other duties as assigned.

Requirements

Education

• High School Diploma or GED
• Degree in Business Administration, Healthcare, or related field preferred

Experience

• Minimum 2 years of billing experience in a medical office or hospital setting
• At least 2 years of experience with EMR/EHR systems
• Minimum 1 year experience working with clearinghouses
• Minimum 1 year experience with NextGen Practice Management systems

Skills and Abilities

• Strong decision-making and problem-solving skills
• Ability to establish and maintain cooperative working relationships
• Ability to evaluate information for compliance with laws, regulations, and standards
• Proficient in gathering and analyzing data and information
• Ability to guide and motivate team members
• Experience monitoring and executing work on revenue cycle management initiatives
• Ability to run reports for analysis, trending, and workload subdivision
• Effective communication of trends and root issues through proper reporting channels
• Ability to meet productivity and key performance indicator standards
• Serve as a resource person for coding specialty
• Willingness to travel occasionally

Compensation and Benefits

• Medical, Dental, Vision, and Life Insurance
• 401(k) retirement plan
• Paid Time Off (PTO)

Location

Positions are based in the Bay Area, California.