AR Claims Specialist I

Join our team at YVFWC as an AR Claims Specialist I in Toppenish, WA!

This role plays a key part in the revenue cycle by researching claim issues, resolving billing errors, and ensuring compliance with payer and regulatory requirements. The AR Claims Specialist also serves as a subject-matter resource for assigned payers and supports team training and process improvement efforts. This role contributes directly to the financial health of YVFWC by ensuring claims are processed correctly and reimbursed in a timely manner. Through diligent follow-up, payer expertise, and collaboration with billing and revenue cycle partners, this role helps reduce denials, improve workflows, and support YVFWC’s mission.

You will:

• Prepare and process insurance claims timely and accurately to government, commercial, and managed care payers
• Review, submit, and/or distribute corrected claims
• Enter appropriate account notes in Epic billing system to clarify actions taken to reconcile claims
• Resolve claim edits daily via claim edit work queues and/or external billing software
• Verify eligibility for coverage via multiple payor websites
• Assure compliance with billing requirements for workers compensation and third-party liability claims
• Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
• Maintain confidentiality of all patient demographics, medical and financial information at all times
• Maintain Epic Claims Work queues to department daily standard
• Maintain daily balance logs of claims sent from EMR to Clearinghouse to ensure all claim runs are balanced
• Perform other duties as assigned