AR Specialist

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

📋 Description

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

• Responsibilities encompass all post-billed denials, including clinical denials.

• Functions as a member of the Denials Resolution team tasked with ensuring payments are collected on denied accounts, identifying root causes for discrepancies, reducing inappropriate payment delays and variances from expected reimbursement, and addressing or escalating issues.

• Engages in daily operations as part of the payment resolution team that receives, analyzes, and appeals denials.

• Reviews, investigates, and resolves payment delays and/or variances stemming from rejected and/or denied claims, overpayments, or underpayments.

• Processes payments as necessary in line with contracts and policies to guarantee timely and precise liability resolution.

• Resolves claims, performs formal account reviews, identifies lost charge recovery opportunities, and analyzes/documents delays and payment variances.

• Recognizes routine issues and resolves or escalates them as needed.

• Keeps abreast of state and federal laws pertaining to contracts and the appeals process.

• Investigates and addresses accounts related to overpayments and underpayments with the aim of maximizing reimbursement.

• Coordinates follow-up with clinical departments to support appeals.

• Works collaboratively with Patient Access and other stakeholders to address account authorization issues.

• Utilizes knowledge of payer rules, contracts, schedules, and additional data sources to resolve payment variances.

• Proactively follows up on delays and variances with patients, commercial, Medicare, and Medi-Cal payers to ensure prompt reimbursement, refiles accurate claims, and documents findings.

• Contacts insurance carriers and patients as necessary to clear outstanding balances.

• Monitors timely filing limits specific to California payers and ensures all claims are submitted within state and payer deadlines.

• Researches payer trends and provides insights to enhance billing accuracy and efficiency.

• Tracks and reports denial types and root causes, suggesting process improvements.

• Analyzes, categorizes, and resolves claim denials from commercial, government, and managed care payers.

• Identifies the root causes of denials (coding errors, eligibility issues, missing documentation, etc.) and collaborates with clinical and coding teams for resolution.

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

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

• Recommends accounts for transfer to collection vendors based on complexity and status.

• Documents all actions in the patient accounting system.

• Addresses patient and payer inquiries or refers them as required.

• Communicates with physicians, office staff, and hospital departments to collect and verify essential information.

• Prepares and submits reports detailing trends, outcomes, and claim activity.

• Cross-trains in various functions to improve service delivery.

• Interprets data, draws conclusions, and reviews findings with the supervisor.

• Engages in continuous learning of all aspects of the Denials Resolution Specialist role.

• Performs additional duties as assigned, maintaining 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, with a minimum of two (2-3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management functions in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or an equivalent combination of education and experience.

• Preferred experience in a complex, multi-site environment within California healthcare systems.

• Exceptional written and verbal communication and organizational skills.

• Strong interpersonal and customer service abilities.

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

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

• Comfortable working in a collaborative, shared leadership environment.

• Previous experience with Global Partner vendors is preferred.

• Experience using Epic is a plus.

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

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

• Ability to work independently, meet deadlines, and maintain a high level of detail orientation.

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

🏝️ Benefits

• Completion of regulatory/mandatory certifications preferred.