Medical Billing Specialist: AR Follow-up & Denials

The Insurance AR & Denials Billing Specialist is responsible for managing and resolving insurance claim denials, ensuring accurate reimbursement, and optimizing revenue cycle performance. The role requires advanced analytical skills, persistence, and the ability to navigate complex payer requirements, including Virginia Medicaid, Managed Care Organizations (MCOs), and vision plans. The specialist demonstrates strong problem-solving abilities and a proactive approach to reimbursement challenges.

Responsibilities include reviewing and analyzing denied and underpaid claims to identify root causes and trends, recognizing denial patterns, interpreting Explanation of Benefits (EOBs), preparing and submitting appeals and corrected claims, resolving claim retractions and recoupments, communicating with insurance carriers to resolve claims, advocating on behalf of the practice, navigating commercial and government payer policies, escalating unresolved issues, monitoring self-pay accounts, coordinating patient communication regarding balances, managing Medicaid and MCO claims, ensuring compliance with billing guidelines, developing solutions for reimbursement challenges, managing multiple claims accurately, collaborating with staff to prevent billing issues, and contributing to best practices for denial prevention and resolution.

The position supports protecting practice revenue, reducing accounts receivable aging, and improving financial performance by ensuring appropriate reimbursement for services rendered.