Insurance AR Specialist

Key Responsibilities

• Submit, monitor, and manage professional and ASC claims to ensure timely reimbursement.
• Review claims for accuracy, ensuring compliance with payer requirements.
• Address and correct claim denials and rejections promptly.
• Conduct follow-up with insurance carriers to resolve unpaid or incorrectly paid claims.
• Research and resolve discrepancies in payment and identify trends in denials or delays.
• Verify insurance benefits and eligibility as needed for accurate billing.
• Reconcile accounts receivable and maintain accurate records of transactions.
• Post payments and adjustments accurately in the system.
• Generate and review aging reports to prioritize collections efforts.

Compliance and Documentation

• Ensure compliance with all applicable billing regulations, HIPAA guidelines, and payer policies.
• Maintain accurate and up-to-date documentation of all interactions with payers and patients.

Collaboration and Communication

• Work closely with clinical staff, coding specialists, and payers to resolve billing and payment issues.
• Provide regular updates to management on AR performance, trends, and challenges.

Requirements

• Minimum of 3 years of experience in insurance AR, specifically with pain management and ASC claims.
• Strong knowledge of professional billing processes, CPT, ICD-10, and HCPCS coding.
• Familiarity with payers such as Medicare, commercial insurance, and workers' compensation.
• Proficiency in medical billing software (e.g., eClinicalWorks, HST, Waystar and Trizetto preferred).
• Advanced knowledge of Excel and ability to interpret data reports.

Skills and Competencies

• Excellent analytical and problem-solving skills.
• Strong communication skills, both written and verbal.
• Ability to manage multiple tasks with a high level of accuracy and efficiency.