POSITION SUMMARY:
The primary responsibility of an A/R Claims Specialist is to follow up with insurance carriers on unresolved claims. This position is also responsible for researching insurance company issues, such as network problems, work comp claims, and a variety of special projects. This position requires a comprehensive understanding of the operational aspects of the entire revenue cycle as well as the appropriate measures to take in resolving claim issues with payers.

Duties & Responsibilities:

• Maintain accounts receivable records ensure aging is up to date, credits and collections are applied, uncollectible amounts are accounted for, and miscellaneous differences are cleared
• File Corrected Claims, Reconsiderations and Appeals
• Resolve denied and rejected claims in a timely manner
• Clear and precise documentation of claim status and details
• Analyzing and interpreting EOBs, documents, contracts, notes, and other correspondence
• Making telephone calls, writing letters, and/or sending faxes to insurance carriers, and other responsible parties in the pursuit of getting a claim resolved and paid
• Writing appeals to insurance carriers to overcomes denials
• Overcome obstacles by using effective information gathered and problem solving with Leadership
• Collaborate with Revenue Cycle Leadership to report denial trends to ensure proper claim resolution
• Identifies deductible, co-insurance due per EOB’s received
• Experienced in using payor online portals to research claim status, submit secondary medical records, conduct claim reconsideration
• Prioritize and process larger volume of denials and maintain high quality of work
• Process charges from a variety of VA facilities utilizing credit card websites and applying payments to patients’ accounts

Qualifications:

• 2-3 years in claim / AR denials in a healthcare environment (Prosthetics & Orthotics preferred but not required)
• Must have ICD-10 knowledge, preferred HCPC coding skills
• PC software experience required along with verbal and written communication skills are crucial (EHR,EMR tasking experience)
• Strong organizational skills, prioritizing and multitasking
• Deadline and detail-oriented
• Dependable, honest, and reliable