AR Specialist

Medical Accounts Receivable (A/R) Revenue Specialist

Position Summary

The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.

Key Responsibilities

Claims & Vendor Management

• Partner with external billing vendors to address claim rejections and payer requests for clarification.
• Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions.
• Review escalated accounts requiring internal oversight or final resolution.

Denial Management & Appeals

• Collaborate with vendor partners to identify denial trends, recurring payer issues, and root causes.
• Provide feedback and strategic direction on appeal approaches and payment resolution tactics.
• Authorize final adjustments after all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance.
• Recommend process improvements to reduce future denials.

Accounts Receivable Follow-Up

• Proactively work A/R aging reports (30, 60, 90+ days) to identify unpaid or underpaid claims.
• Initiate payer tracers and follow-ups to secure claim adjudication and payment.
• Monitor high-risk and high-dollar accounts to prevent revenue leakage.

Payment Posting & Reconciliations

• Ensure accurate posting and reconciliation of insurance and patient payments.
• Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy.
• Assist with account reconciliations and discrepancies resolution as needed.

Patient & Insurance Communication

• Act as a liaison between patients and insurance payers to resolve billing questions.
• Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.
• Conduct professional and empathetic phone communication with patients and payer representatives.

Qualifications & Requirements

Education

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred

Experience

• 1–3 years of experience in:
• Medical billing and collections
• Accounts Receivable or Revenue Cycle Management
• Healthcare payer follow-up and denial resolution

Technical Skills

• Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)
• Strong working knowledge of Microsoft Office, particularly:
• Excel (reports, aging analysis)
• SharePoint

Medical & Regulatory Knowledge

• Working knowledge of:
• Medical terminology
• CPT and ICD-10 coding
• Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans

Core Competencies

• Strong analytical and problem-solving skills
• Exceptional attention to detail and accuracy
• Effective written and verbal communication skills
• Ability to work collaboratively with internal teams and external vendor partners
• Sound judgment related to financial adjustments and account resolution