AR Specialist 2 - Complex Clinical Denials

Core responsibilities

• Verify or obtain eligibility and/or authorization using payer websites, client eligibility systems, or phone calls
• Update patient demographics and insurance information in appropriate systems
• Research unpaid or denied claims and monitor for missing information, authorization, and control numbers
• Review EOBs for payments or adjustments to resolve claims
• Contact payers by phone or written correspondence to secure payment and submit reconsiderations/appeals
• Adhere to state and federal claims and appeal guidelines
• Access client systems for payment, patient, claim, and data information
• Follow prioritization, timely filing deadlines, and notation protocols
• Secure medical documentation requested by third-party insurance carriers
• Maintain patient confidentiality and meet productivity/performance expectations

Minimum qualifications

• 2–3 years of medical collections, denials, and appeals experience
• Experience handling denials such as DRG downgrades, level of care, coding, medical necessity, experimental, bundling, noncovered, and no authorization
• Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI
• Intermediate knowledge of third-party billing guidelines
• Intermediate knowledge of billing claim forms (UB04/1500)
• Intermediate knowledge of payor contracts for commercial and government payers
• Intermediate working knowledge of Microsoft Word and Excel
• Intermediate knowledge of health information systems such as EMR, claim scrubbers, and patient accounting systems

Preferred qualifications

• Experience with EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, Allscripts, Paragon, or similar patient accounting systems
• Intermediate knowledge of DDE Medicare claim system
• Intermediate knowledge of government rules and regulations