AR Specialist

A/R Specialist

The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues.

• Prepares, submits, and follows up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.
• Verifies all the information for claims processing is complete.
• Contacts the appropriate person to obtain missing or unclear billing.
• Follows up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims.
• Sends appeal letters to insurance.
• Obtains authorizations when needed.
• Identifies and corrects charge entry/billing.
• Provides proper documentation to insurance companies.
• Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous manner.
• Documents all actions and maintains permanent records of patient.
• Assists with answering phones, screening calls and following up on.
• Works with management on patient billing and insurance.
• Processes refunds to patients and insurance.
• Works with outside programs (i.e., co-pay assistance) to ensure proper.
• Communicates with front office staff to attempt to collect any outstanding patient.
• Contributes to the team effort by completing other tasks and projects as needed.

Qualifications

• Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system.
• CPC, CPOC, COC certifications a plus.
• Six months of previous customer service experience preferred.
• Prior experience with an electronic medical record system required (EHR/EMR).

Skills

• Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations.
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
• Maintains knowledge of coordination of benefits requirements and processes.
• Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary.
• Self-motivated with strong organizational skills and superior attention to detail.
• Ability to handle sensitive and confidential information in a professional manner.
• Ability to work well under pressure.
• Ability to multi-task, set priorities and follow through without direct supervision.
• Effectively communicate with physicians, patients, insurers, colleagues, and staff.
• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level.
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams.

Benefits

We offer a competitive benefits package to our employees including Medical, Dental, Vision, 401k with Match, HSA/FSA, Telemedicine, Generous PTO Package, Employee Discounts and Perks, Employee Assistance Program, Group Life/AD&D, Short Term Disability Insurance, Long Term Disability Insurance.

About the Role

Join Houston Retina Associates At Houston Retina Associates, we’re more than a leading ophthalmology practice—we’re a team dedicated to preserving and restoring vision for our patients. Specializing in advanced care for retinal conditions like macular degeneration, diabetic retinopathy, and retinal detachment, we combine cutting-edge technology with compassionate, personalized treatment. Our culture is built on collaboration, innovation, and continuous learning. We value every team member’s contribution and provide opportunities for professional growth in a supportive environment. With multiple locations across the greater Houston area, we’re proud to serve our community and make a meaningful impact every day.