AR Specialist 2, Complex Clinical Denials

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

📋 Description

• Verify or obtain eligibility and/or authorization through payer websites, client eligibility systems, or phone communication.

• 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).

• Analyze EOBs to identify payments or adjustments necessary for resolving claims.

• Reach out to payers via phone or written correspondence to ensure claim payments are secured.

• Submit requests for reconsiderations and appeals.

• 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 requested by third-party insurance carriers.

• Maintain the confidentiality of patient information in line with collection guidelines and corporate policies.

• Meet productivity and performance expectations associated with the role.

• Execute other related responsibilities as required.

⛳️ Requirements

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

• Experience with denials and appeals, including DRG downgrades, level of care, coding, medical necessity, experimental treatments, bundling, non-covered services, and lack of authorization.

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

• Intermediate familiarity with third-party billing guidelines.

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

• Intermediate understanding of payer contracts—both commercial and government.

• Intermediate working knowledge of 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 like EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon.

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

• Preferred: Intermediate understanding of government rules and regulations.

🏝️ Benefits

• Certified Great Place to Work for 4 consecutive years.

• Equal Opportunity Employer.