Job Summary:

The Senior AR Follow-up Specialist is responsible in managing escalated insurance claim denials and outstanding accounts to ensure timely resolution and accurate reimbursement. The role analyzes denial trends, files corrected or appealed claims, and collaborates with internal and external stakeholders to support efficient claims processing and payment resolution.

Job Description:

• Performs daily follow-up on escalated or denied claims to ensure timely processing, reprocessing, and payment resolution.

• Reviews and reconciles outstanding accounts, including identifying unposted or unidentified payments.

• Files corrected claims and submits appeals when appropriate, ensuring compliance with payer and regulatory requirements.

• Analyzes denial trends and reports findings to leadership to support claim resolution strategies.

• Collaborates with insurance companies, patients, vendors, and internal departments to resolve billing discrepancies and account conflicts.

• Ensures adherence to compliance policies, operational procedures, and Practice Management System workflows.

• Supports process improvement initiatives related to claims escalation and denial management.

• Maintains accurate documentation of claim status, communications, and account updates.

• Completes mandatory compliance training and maintains adherence to company standards and core values.

• Performs additional administrative and operational tasks as assigned.

Qualifications:

• Demonstrates strong understanding of payer rules and workflows.

• Applies working knowledge of healthcare revenue cycle processes, particularly AR and denials management.

• Manages multiple priorities effectively in a fast-paced environment.

• Demonstrates strong analytical and critical thinking skills in claims review and denial resolution.

• Demonstrates strong attention to detail and organizational skills.

• Exercises sound judgment and timely decision-making when resolving escalations.

• Maintains professionalism, integrity, and confidentiality at all times.

• Clear and coherent both written and verbal communication skills in English to internal teams, payers, and patients.

Screening Criteria:

• High school diploma or equivalent.

• Minimum of four (4) years experience in claims escalation or AR denials within a healthcare setting.

• Experience in end-to-end adjudication and denial management.

• Experience communicating with providers/clinics (calls, coordination).

• Experience in AthenaOne system.

• Experience in Microsoft Excel and tools related in clearinghouse, practice management systems.

• Must have stable employment history.

Benefits & Perks:

• Rice Allowance

• Internet Allowance

• Overtime Pay & Holiday Pay

• Night Differential

Bonuses & Incentives:

• Perfect Attendance Bonus (terms apply)

• 13th Month Pay

• Mid-Year Bonus

• Annual Merit Increase

Health & Insurance:

• HMO for Employee

• HMO for Dependents

• Group Life Insurance

Time Off:

• Paid Time Off (PTO) with monthly accrual

Senior AR Follow-up Specialist - Work Onsite