This in-office Medical A/R Specialist role focuses on managing claim denials, payer follow-up, and appeal activities to help achieve positive claim outcomes.
Key responsibilities include:
- Evaluating claim denials and determining next steps
- Identifying and reporting payer denial, low payment, and recoupment trends
- Contacting payers and facilities, with phone work required most of the day
- Accessing payer portals to submit documentation requests, review claim adjudications, and obtain EOBs
- Preparing written documentation and maintaining files
- Updating accounts and maintaining Excel spreadsheets with follow-up notes
- Working with multiple PM and EMR systems
- Managing a high-volume workflow with strong organization
- Handling claims appeals for multiple companies
- Maintaining HIPAA compliance and confidentiality
- Performing other related duties as assigned
Requirements & Qualifications
- Minimum 1 year of accounts receivable experience in the medical field
- Proficiency with Microsoft Office, especially Word and Excel
- Working knowledge of PM and EMR software applications or the ability to learn quickly
- Strong organizational skills and ability to manage a high-volume workload
- Knowledge of in-network and out-of-network processes, including ERISA
- Familiarity with state and federal claims processing and insurance guidelines
- Ability to work independently and as part of a team
- Strong oral and written communication skills
- Excellent customer service and problem-solving skills
- Experience with split modified claims (Pro/Tech) preferred
- Knowledge of specialties such as intraoperative monitoring, anesthesiology, orthopedic surgery, neurosurgery, radiology, and AEEG preferred but not required
Benefits & Perks
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Location
Texas, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
2 weeks ago
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