We are seeking a detail-oriented and proactive Healthcare Billing and AR Specialist to support accurate and efficient billing and accounts receivable operations. In this role, you will manage claim processing, denial resolution, appeals, payer follow-up, and reimbursement recovery to ensure timely and accurate payment while maintaining compliance with payer requirements and industry standards.
Key Responsibilities
- Prepare, review, and submit medical claims (electronic and paper), including CMS-1500 (HCFA) and/or UB-04 (CMS-1450) forms, ensuring accuracy and compliance with payer requirements.
- Ensure accurate claim details, including ICD-10, CPT/HCPCS codes, revenue codes, modifiers, and provider/facility information.
- Review and resolve denied, rejected, unpaid, or underpaid claims through claim corrections, resubmissions, appeals, and payer follow-up.
- Manage accounts receivable activities, including researching outstanding balances and recovering reimbursements from insurance carriers.
- Prepare and submit appeals, including supporting documentation and appeal letters, to maximize reimbursement.
- Review EOBs and ERAs to reconcile payments and identify reimbursement discrepancies.
- Monitor payer filing requirements and ensure claims, corrections, and appeals are submitted within required timeframes.
- Communicate with insurance carriers and internal stakeholders to resolve billing and reimbursement issues.
- Maintain accurate documentation of claim status, collection efforts, and payer communications.
- Meet productivity, quality, and collection goals while maintaining compliance with payer guidelines and regulatory requirements.
Required Qualifications
- Minimum 1 year and 6 months of healthcare billing, accounts receivable, insurance collections, or denial management experience.
- Experience working with CMS-1500 (HCFA) and/or UB-04 (CMS-1450) claims.
- Strong knowledge of ICD-10, CPT, HCPCS, revenue codes, and modifiers.
- Experience handling claim processing, denial management, appeals, claim corrections, resubmissions, and payer follow-up.
- Experience managing accounts receivable and resolving unpaid or underpaid claims.
- Strong understanding of payer requirements, reimbursement processes, claim adjudication, and timely filing guidelines.
- Experience reviewing EOBs and ERAs and resolving payment discrepancies.
- Strong analytical, organizational, problem-solving, and communication skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Nice to Have
- Experience working facility claims, physician claims, or both.
- Familiarity with Medicare, Medicaid, and commercial payer guidelines.
- Experience with EMR/EHR systems and medical billing platforms.
- Experience managing multiple client systems or high-volume accounts.
- Knowledge of healthcare revenue cycle management processes.
