AR Specialist, Physician Billing

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

📋 Description

• Collaborate on eligibility, demographics, billing, edit resolution, accounts receivable follow-up, and denial management.

• Confirm insurance coverage and benefits utilizing payer portals, EDI 270/271 transactions, and direct payer communication.

• Establish the order of primary, secondary, and tertiary payers.

• Recognize scenarios involving prior authorization, pre-certification, referrals, Medicare Secondary Payer, workers’ compensation, motor vehicle accidents, and third-party liabilities.

• Review and amend patient, guarantor, subscriber, and insurance information within EHR, PMS, or registration systems.

• Submit accurate claims directly to Medicare DDE/FISS, state Medicaid portals, and designated payer channels.

• Address claim edits, scrubber rejections, and pre-submission errors.

• Correct UB-04 and CMS-1500 claim information, including codes, modifiers, place of service, and provider details.

• Manage aged accounts receivable, focusing on high-dollar and high-aging balances.

• Communicate with payers to ascertain claim status and resolve reasons for denials or pending statuses.

• Investigate and address denials and underpayments through rebilling, reconsiderations, appeals, corrected claims, and medical record submissions.

• Prepare and dispatch written appeals, accompanied by supporting documentation.

• Identify and pursue underpayments based on expected contractual terms.

• Oversee payer follow-up across Medicare, Medicaid, commercial, managed care, workers’ compensation, TRICARE, and VA.

• Analyze trends in rejections and denials and escalate data-driven recommendations.

• Collaborate with coding, charge capture, patient access, HIM, and client-side teams.

• Document account activities in source systems.

• Uphold productivity, quality, HIPAA compliance, payer standards, CMS regulations, and billing regulations.

⛳️ Requirements

• High School Diploma or GED.

• 3-5 years of experience in hospital and/or physician revenue cycle, with expertise in at least two key areas.

• Practical experience submitting claims directly to payers via Medicare DDE/FISS, state Medicaid portals, and/or specific payer submission channels.

• Proven ability to work effectively within client EHR, PMS, and billing systems.

• In-depth knowledge of UB-04 and CMS-1500 claim forms, revenue codes, CPT/HCPCS, ICD-10-CM, and modifier usage.

• Expertise in Medicare, Medicaid, TRICARE, VA, and commercial payer processes.

• Familiarity with NCCI edits, MUE edits, LCD/NCD policy logic, and bundling rules.

• Hands-on experience with major payer portals and EDI 270/271 eligibility transactions.

• Understanding of coordination of benefits, payer determination, and Medicare Secondary Payer regulations.

• Ability to interpret EOBs, remittance advices, contracts, and payment documentation.

• Proficient Excel skills, including filtering, sorting, pivot tables, and basic formulas.

• Knowledgeable about HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations.

• Capable of prioritizing workload and managing various responsibilities.

• CRCR or CRCS certification preferred.

• 6+ years of cross-functional hospital revenue cycle experience preferred.

• Experience with Medicare FISS/DDE adjustment workflows preferred.

• Familiarity with UB-04 and CMS-1500 claim types preferred.

• Bilingual in English and Spanish preferred.

🏝️ Benefits

• Access to a 401(k) Retirement Savings Plan.

• Comprehensive Medical, Dental, and Vision Coverage.

• Paid Time Off.

• Paid Holidays.

• Pet Care Coverage.

• Employee Assistance Program (EAP).

• Discounted services.

• Flexible work hours when feasible.

• A dynamic and inclusive workplace culture.