Performs advanced level work related to denial management.
Processes and follows up on all appeal types, at an expert level, to all payers.
Takes actionable steps to resolve open claims, as needed, including refiling or appealing claims, or resolving manual tasks assigned to AR for review.
Works outstanding accounts receivable from assigned projects.
Functions as an SME across multiple workflows and various payers.
Provides peer payer and system training support.
Identifies denial patterns and escalates to management for follow-up and/or root cause resolution.
Makes recommendations to work queues and claim edits to improve efficiency and reduce denials.
Reviews payer communications related to changes in medical and reimbursement policies.
Researches payer trends identified by offshore partners to recommend training/process improvement.
Identifies opportunities for and actively participates in process improvement initiatives.
Maintains strictest confidentiality.
Maintains basic proficiency with using spreadsheets.
Maintains productivity and quality standards established by RCM.
All other duties as assigned.

High school graduate or equivalent.
Associate or bachelor’s degree in business administration or related field of study preferred.
Minimum of 3 years accounts receivable experience preferred.
Excellent verbal and written skills to maintain professionalism in all methods of communication.
Basic math skills for calculating anesthesia units, proper reimbursement, and percentages for appropriate adjustments.
General understanding of medical terminology.
Advanced knowledge of insurance processing, payer policies, guidelines, and explanation of benefits (EOB’s).
Knowledge of commercial payer, Medicare, and Medicaid guidelines.
Data entry skills with high accuracy.
General knowledge and understanding of CPT, ICD-10, and ASA codes.
Good problem-solving skills.
Decision making ability with sound judgment.
Strong analytical skills and attention to detail, including gathering and aggregating information.
Ability to work effectively with all team members, including physicians and external vendors or patients.
Must be able to work in a virtual team environment.
Ability to work independently with limited supervision.
Computer application skills to include MS Word, MS Excel, MS Outlook, and MS Teams.

Accounts Receivable Specialist

Key skills