AR Specialist 2 – Complex Clinical Denials

This is a fully remote position, open to applicants in United States.

📋 Description

• Verify or obtain eligibility and authorization through payer websites, client eligibility systems, or by contacting insurance carriers/providers via telephone.

• Update patient demographics and insurance details in the relevant systems.

• Investigate and track unpaid or denied claims.

• Monitor claims to identify any missing information, authorization, and control numbers (ICN/DCN).

• Analyze EOBs for payments or adjustments to resolve claims efficiently.

• Reach out to payers through phone or written communication to ensure claim payments are secured.

• Submit reconsiderations and appeals as necessary.

• Comply with state and federal guidelines regarding claims and appeals.

• Access client systems to retrieve payment, patient, claim, and data information.

• Adhere to prioritization guidelines, timely filing deadlines, and documentation protocols.

• Obtain medical documentation required or requested by third-party insurance carriers.

• Ensure the confidentiality of patient information is maintained.

• Meet productivity and performance expectations specific to the role.

• Execute other related duties as needed.

⛳️ Requirements

• 2–3 years of experience in medical collections, denials, and appeals.

• Familiarity with denials and appeals processes, including DRG downgrades, level of care, coding, medical necessity, experimental procedures, bundling, noncovered services, and lack of authorization.

• Intermediate understanding of ICD-10, CPT, HCPCS, and NCCI.

• Intermediate knowledge of third-party billing guidelines.

• Intermediate familiarity with UB-04 and 1500 billing claim forms.

• Intermediate understanding of commercial and government payer contracts.

• Intermediate working proficiency in Microsoft Word and Excel.

• Intermediate knowledge of health information systems, including EMR, claim scrubbers, and patient accounting systems.

• Preferred: Intermediate knowledge of patient accounting systems such as EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon.

• Preferred: Intermediate understanding of the DDE Medicare claim system.

• Preferred: Intermediate familiarity with government rules and regulations.

🏝️ Benefits

• Certified Great Place to Work for four consecutive years.

• Equal Opportunity Employer.