AR Follow-up and Denial Specialist

Responsibilities

• Monitor and follow up on unpaid or partially paid insurance claims within designated timeframes.
• Review denied claims to identify reasons for denials, such as coding errors or documentation issues, and take corrective action to resubmit or appeal when needed.
• Analyze claim rejections related to DRG, CPT, ICD-9, ICD-10, and ICD coding discrepancies to support accurate reimbursement.
• Collaborate with clinic and coding teams to verify medical records, ensure proper documentation, and resolve payment-related discrepancies.
• Maintain detailed records of follow-up activities, appeals, and correspondence with payers and patients in EMR/EHR systems.
• Communicate with insurance companies, healthcare providers, and patients to clarify information and expedite resolution of outstanding balances.
• Stay updated on industry regulations, payer policies, and coding guidelines to ensure compliance and maximize reimbursement.
• Provide education to team members on payer policies and denial prevention.

Skills and Qualifications

• Strong knowledge of medical billing processes and collection strategies in a healthcare setting.
• Proficiency in medical coding concepts including DRG, CPT, ICD-9, ICD-10, and ICD systems.
• Experience working with EMR/EHR systems for documentation management and claim tracking.
• Understanding of medical terminology and medical records review procedures.
• Ability to analyze complex claims data to identify denial or underpayment issues.
• Effective communication skills for working with payers, providers, and patients.
• Strong organizational skills and attention to detail to manage multiple accounts accurately.
• Medical billing experience preferred: 2 years.

Benefits

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance