Carolina Oncology Specialists has been providing compassionate, patient-centered care since 1983, delivering high-quality oncology and hematology services tailored to each individual's needs.
The Accounts Receivable (AR) Insurance Analyst is responsible for managing and resolving outstanding insurance balances to ensure timely and accurate reimbursement for services rendered. This role focuses on analyzing payer activity, identifying reimbursement discrepancies, and driving resolution of denied or underpaid claims to support optimal revenue cycle performance.
Key Responsibilities
- Review and analyze insurance accounts receivable to identify unpaid, underpaid, or denied claims.
- Investigate and resolve claim denials by reviewing payer policies, coding, and documentation requirements.
- Submit and track appeals to insurance companies, ensuring timely follow-up and resolution.
- Work payer-specific work queues to address aging accounts and reduce days in AR.
- Analyze trends in denials and underpayments, escalating systemic issues to leadership.
- Collaborate with coding, billing, and clinical teams to resolve claim errors and prevent future issues.
- Verify payer reimbursement accuracy based on contractual agreements.
- Maintain thorough and accurate documentation of all account activity, follow-up efforts, and resolutions.
- Work claim edits and clearinghouse rejections to ensure timely resubmission.
- Communicate with insurance representatives to obtain claim status, clarify reimbursement issues, and expedite payments.
- Assist in identifying process improvement opportunities to enhance revenue cycle efficiency.
- Support reporting efforts related to AR performance, denial trends, and payer behavior.
- Ensure compliance with all regulatory and payer guidelines.
Requirements & Qualifications
Required Qualifications
- High school diploma or equivalent required; associate's or bachelor's degree in Healthcare Administration, Finance, or related field preferred.
- 2–4 years of experience in medical billing, insurance follow-up, or accounts receivable within a healthcare setting.
- Strong knowledge of insurance claim processing, EOBs/ERAs, denial management, and payer requirements.
- Familiarity with CPT, ICD-10, and HCPCS coding concepts.
- Experience working with practice management systems and Microsoft Excel.
- Strong analytical, problem-solving, and critical thinking skills.
- Excellent attention to detail and organizational abilities.
- Effective written and verbal communication skills.
Preferred Qualifications
- Experience in oncology or other specialty practice environments.
- Knowledge of payer contracts and reimbursement methodologies.
- Experience with appeals and escalation processes for complex claims.
- Understanding of regulatory requirements affecting healthcare revenue cycle operations.
Key Competencies
- Analytical thinking
- Problem resolution
- Attention to detail
- Accountability and follow-through
- Communication and collaboration
- Time management
Location
North Carolina, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago