AR Specialist

Key Responsibilities

• Comprehensive Claims Management: Oversee the entire lifecycle of medical claims, from initial receipt and adjudication through to final resolution, appeal, or payout.
• Behavioral Health Specialization: Manage complex claims specific to behavioral and mental health services, ensuring accurate alignment with specialized coding and documentation standards.
• Quality Assurance & Compliance: Audit submissions for accuracy and policy alignment, ensuring full compliance with payer guidelines, HIPAA, and CMS regulations.
• Real-Time Verification: Validate patient benefits and coverage eligibility swiftly to prevent processing delays, particularly regarding mental health benefits.

Required Qualifications

• Experience: Minimum of 1 year of hands-on experience in end-to-end healthcare claims processing, denial management, appeals, or claims analysis specifically within a BPO setting.
• Domain Expertise: Proven experience handling Behavioral Health / Mental Health claims and billing workflows.
• System Proficiency: Practical experience utilizing AMD (AdvancedMD) software for claims management, scheduling, or billing functions is highly preferred.
• Technical Knowledge: Solid understanding of medical coding systems (ICD-10, CPT, HCPCS), diverse claim types, and industry-standard regulations (HIPAA, CMS, etc.).
• Core Skills: Strong verbal and written communication abilities, a sharp eye for detail, and the flexibility to thrive both independently and collaboratively in a high-volume environment.