AR Specialist

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

📋 Description

• Execute daily payment resolution tasks within Hospital and/or Medical Group partner revenue operations.

• Receive, assess, and appeal post-billed denials, including those related to clinical matters.

• Review, research, and address payment delays and discrepancies stemming from rejected or denied claims, overpayments, and underpayments.

• Process payments in accordance with contracts and policies to ensure timely and accurate liability resolution.

• Resolve claims, carry out formal account reviews, identify lost charge recovery opportunities, and document delays and payment discrepancies.

• Recognize routine issues and either resolve or escalate them as necessary.

• Maintain an understanding of state and federal regulations pertaining to contracts and appeals.

• Investigate accounts related to overpayments and underpayments to maximize reimbursement.

• Coordinate with clinical departments to facilitate appeals.

• Collaborate with Patient Access and other stakeholders to address authorization matters.

• Apply payer rules, contracts, schedules, and related data to resolve payment discrepancies.

• Follow up with patients and commercial, Medicare, and Medi-Cal payers; refile accurate claims and document findings.

• Communicate with insurance carriers and patients to settle outstanding balances.

• Monitor California payer timely-filing limits and ensure claims are submitted within the appropriate deadlines.

• Research payer trends and provide insights to enhance billing accuracy and efficiency.

• Track and report types of denials and their root causes, recommending process enhancements.

• Analyze, categorize, and address claim denials from commercial, government, and managed care payers.

• Identify the root causes of denials and collaborate with clinical and coding teams for resolution.

• File appeals and reconsiderations in accordance with California-specific timelines.

• Request write-offs, transfers, allowances, and reversals as necessary.

• Recommend accounts for transfer to collection agencies.

• Document actions taken in the patient accounting system.

• Respond to or redirect patient and payer inquiries.

• Communicate with physicians, office staff, and hospital departments to gather and verify information.

• Prepare reports on trends, outcomes, and claims activity.

• Cross-train in various operational functions.

• Interpret data, draw conclusions, and review findings with a supervisor.

• Commit to continuous learning in all facets of the Denials Resolution Specialist role.

• Perform other assigned duties as needed.

• Maintain a working knowledge of applicable Federal, State, and local laws and regulations.

⛳️ Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or a related field, along with at least two to three years of experience in revenue cycle medical billing, insurance follow-up, and denial management within a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or a combination of education and experience that is equivalent.

• Experience in a complex, multi-site environment within California healthcare systems is preferred.

• Excellent written and verbal communication and organizational abilities.

• Strong interpersonal and customer service skills.

• High attention to detail, accuracy, and effective time management.

• Basic proficiency in Microsoft Office Suite (Outlook, Word, PowerPoint, Excel).

• Completion of regulatory or mandatory certifications is preferred.

• Comfortable working in a collaborative leadership environment.

• Prior experience with Global Partner vendors is preferred.

• Experience using the Epic system.

• Familiarity with CPT, ICD-10, and HCPCS coding.

• Strong organizational, communication, and problem-solving skills.

• Ability to work independently, meet deadlines, and maintain a keen attention to detail.

• Preferred Certification: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or an equivalent certification.

🏝️ Benefits

• Comprehensive health, dental, and vision plans.

• Retirement savings plan with employer matching.

• Paid time off and holiday pay.

• Opportunities for professional development and growth.

• Supportive work environment that promotes work-life balance.