AR Specialist

Duties And Responsibilities

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values.
• Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials.
• Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims, overpayments, or underpayments.
• Processes payments as appropriate in accordance with contracts and policies to ensure timely and accurate liability resolution.
• Solves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes/document delays and payment variances.
• Identifies routine issues and resolves or escalates them as appropriate.
• Maintains knowledge of state and federal laws as they relate to contracts and the appeals process.
• Investigates and addresses overpayment and underpayment accounts with the goal of optimizing reimbursement.
• Collaborates with Patient Access and other stakeholders to resolve account authorization issues.
• Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances.
• Proactively follows up on delays and variances with patients, commercial, Medicare, and Medi-Cal payers to ensure prompt reimbursement, refiles accurate claims, and documents findings.
• Contacts insurance carriers and patients as necessary to resolve outstanding balances.
• Maintains timely filing limits specific to California payers and ensures all claims are submitted within state and payer deadlines.
• Researches payer trends and provides feedback to improve billing accuracy and efficiency.
• Tracks and reports denial types and root causes, recommending process improvements.
• Analyzes, categorizes, and resolves claim denials from commercial, government, and managed care payers.
• Identifies root causes of denials (coding errors, eligibility issues, missing documentation, etc.) and works with clinical and coding teams for resolution.
• Filings appeals and reconsiderations according to California-specific appeal timelines.
• Requests write-offs, transfers, allowances, and reversals as needed.
• Recommends accounts for transfer to collection vendors based on complexity and status.
• Documents all actions in the patient accounting system.
• Responds to patient and payer inquiries or refers them as needed.
• Communicates with physicians, office staff, and hospital departments to gather and verify necessary information.
• Prepares and submits reports documenting trends, outcomes, and claim activity.
• Cross-trains in various functions to enhance service delivery.
• Interprets data, draws conclusions, and reviews findings with supervisor.
• Continuously learns all aspects of the Denials Resolution Specialist role.
• Maintains a working knowledge of applicable Federal, State, and local laws/regulations.

Requirements

• A high school diploma or Associate degree in Accounting, Business Administration, or related field, with a minimum of two (2-3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management functions in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or an equivalent combination of education and experience.
• Experience in a complex, multi-site environment within California healthcare systems preferred.
• Excellent written and verbal communication and organizational skills.
• Strong interpersonal and customer service skills.
• Attention to detail, accuracy, and time management.
• Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel).
• Completion of regulatory/mandatory certifications preferred.
• Comfortable working in a collaborative, shared leadership environment.
• Previous experience with Global Partner vendors preferred.
• Experience using Epic.
• Familiarity with CPT, ICD-10, and HCPCS coding.
• Strong organizational, communication, and problem-solving skills.
• Ability to work independently, meet deadlines, and maintain high attention to detail.
• Preferred Certification: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent.