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 via phone.

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

• Investigate and track unpaid or denied claims.

• Monitor claims for any missing information, authorization, and control numbers.

• Analyze EOBs for payments or adjustments to resolve claims.

• Communicate with payers through phone or written correspondence to secure claim payments and submit reconsiderations and appeals.

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

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

• Follow prioritization, adhere to timely filing deadlines, and maintain notation protocols.

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

• Ensure patient confidentiality in accordance with insurance collection guidelines and corporate policies.

• Meet productivity and performance-based expectations for the role.

• Carry out other related duties as necessary.

⛳️ Requirements

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

• Proficient in handling denials and appeals, including DRG downgrades, level of care, coding, medical necessity, experimental procedures, bundling, non-covered services, and lack of authorization.

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

• Intermediate knowledge of third-party billing guidelines.

• Intermediate familiarity with billing claim forms (UB04/1500).

• Intermediate comprehension of payor contracts—both commercial and government.

• Intermediate proficiency in Microsoft Word and Excel.

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

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

• Preferred: Intermediate familiarity with the DDE Medicare claim system.

• Preferred: Intermediate understanding of government rules and regulations.

🏝️ Benefits

• Comprehensive health insurance package.

• Competitive salary with performance-based incentives.

• Opportunities for professional development and growth.

• Flexible work hours and a supportive work environment.