[Hiring] Medical AR Denials and Edits Specialist @CorroHealth

Role Description

Reporting to the Manager, AR Services, the AR Specialist is responsible for ensuring the timely collections of outstanding government or commercial healthcare insurance receivables. The AR Specialist follows up on outstanding A/R for all payers, including self-pay and resolution of denials.

Essential Duties and Responsibilities

• Interacting with insurance plans, patients, physicians, attorneys, and fellow Team Members as needed.
• Verifying or obtaining patient eligibility and/or authorization for healthcare services.
• Updating patient demographics and/or insurance information in appropriate systems.
• Conducting research and appropriately status unpaid or denied claims.
• Monitoring claims for missing information, authorization, and control numbers (ICN/DCN).
• Researching EOBs for payments or adjustments to resolve claims.
• Contacting payers by phone or through written correspondence to secure payment of claims.
• Accessing client systems for information regarding received payments, open claims, and other data necessary to resolve claims.
• Following guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
• Securing medical documentation as required or requested by third-party insurance carriers.
• Obtaining billing guidelines and requirements by researching provider billing manuals.
• Writing appeal letters for technical appeals.
• Verifying accuracy of underpayments by researching contracts and claims data.
• Preparing claims for clinical audit processing in the event of an authorization, coding, level of care, and/or length of stay denial.

Qualifications

• 3+ years of accounts receivable experience within the healthcare revenue cycle.
• Minimum of 2 years’ experience with Medi-Cal.
• 2+ years of experience with healthcare and/or insurance billing and processing.
• Experience with professional physician and hospital facility claims.
• Ability to read and interpret an EOB.
• Knowledge and understanding of UB04 and HCFA 1500 forms.
• High School diploma.
• Proficiency with Outlook, Excel, and Word.
• Ability to communicate in a professional and clear manner.
• Strong interpersonal skills.
• Ability to work independently, with analytical and critical thinking skills.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Members must be able to lift and move material weighing up to 20 lbs. Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.