Medical A/R Specialist

The Medical A/R Specialist is responsible for reviewing claims, following up with insurance carriers and patients, and reporting trends in accounts receivable to the lead or manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Process claims over 60-days in a timely manner

• Work assigned denials and correspondence 

• Utilize clearinghouse and insurance portals to check claim status

• Identify and report trends detected to management

• Prepare corrected claims and appeals, as needed

• Process inbound and outbound calls as needed to insurance carriers

• Comply with all state and federal collections and HIPAA regulations

• Perform other job-related duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong professional communication skills

• Detail-oriented with strong organizational skills

• Knowledge of managed care plans, insurance processes, and medical terminology

• Familiarity with reimbursement fee schedules (Medicare and Medicaid)

• Understanding of refund processes and requirements

• Ability to establish and maintain cooperative working relationships with staff

• Ability to prioritize tasks and manage multiple assignments simultaneously

• Proficiency with accounts receivable software, insurance portals, and Microsoft Office applications

EDUCATION AND EXPERIENCE

• High school diploma or equivalent required; associate’s degree or higher preferred.

• Experience in Medicare A/R, commercial insurance, appeals, correspondence, and denials preferred.

WORKING CONDITIONS

Prolonged sitting or standing at a desk while utilizing a computer.