AR Specialist 2 – Complex Clinical Denials

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

📋 Description

• Verify or acquire eligibility and authorization through payer websites, client eligibility systems, or by contacting insurance carriers/providers 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 (ICN/DCN).

• Examine EOBs for payments or adjustments to address claims.

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

• Adhere to state and federal claim and appeal regulations.

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

• Follow prioritization guidelines, timely filing deadlines, and documentation protocols.

• Obtain necessary medical documentation from third-party insurance carriers.

• Uphold patient-information confidentiality in line with insurance collection guidelines and corporate policies.

• Achieve productivity and performance targets.

• Carry out other related tasks as required.

⛳️ Requirements

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

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

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

• Intermediate understanding of third-party billing guidelines.

• Intermediate knowledge of billing claim forms (UB04/1500).

• Intermediate familiarity with payor contracts—both commercial and government.

• Intermediate working knowledge of Microsoft Word and Excel.

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

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

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

• Preferred: Intermediate knowledge of governmental rules and regulations.

🏝️ Benefits

• Competitive salary.

• Opportunities for professional development.

• Comprehensive health and wellness benefits.

• Supportive work environment.