Job Summary
The Senior AR Follow-up Specialist is responsible for managing escalated insurance claim denials and high-value outstanding accounts to ensure timely resolution and accurate reimbursement. This role involves analyzing denial trends, submitting corrected claims and appeals, and collaborating with internal teams and external stakeholders to optimize claims processing and drive successful payment outcomes.
Key Responsibilities
- Perform daily follow-ups on escalated and denied claims to ensure timely processing, reprocessing, and resolution
- Review and reconcile outstanding accounts, including identifying unposted or unidentified payments
- Prepare and submit corrected claims and appeals in compliance with payer guidelines and regulatory requirements
- Analyze denial trends and provide actionable insights to leadership to improve resolution strategies
- Coordinate with insurance companies, patients, vendors, and internal departments to resolve billing discrepancies
- Ensure adherence to compliance policies, operational procedures, and Practice Management System workflows
- Support continuous improvement initiatives related to claims escalation and denial management
- Maintain accurate and detailed documentation of claim status, communications, and account updates
- Complete required compliance training and uphold company standards and core values
- Perform additional administrative and operational tasks as needed
Screening Criteria
- High school diploma or equivalent
- Minimum of 4 years of experience in AR follow-up, claims escalation, or denial management within a healthcare setting
- Experience handling Medicare, Medicaid, Tricare, and VA payers
- Strong background in end-to-end claims adjudication and denial resolution
- Experience coordinating with providers and clinics (calls, follow-ups, and issue resolution)
- Proficiency in Microsoft Excel and familiarity with clearinghouse and practice management systems
- Stable employment history
- Amenable to working onsite in any of the following locations: Angeles, Ortigas, Davao, or Cebu
Required Qualifications
- Strong understanding of payer rules, guidelines, and workflows
- Solid knowledge of healthcare revenue cycle processes, particularly AR follow-up and denial management
- Ability to manage multiple priorities in a fast-paced environment
- Excellent analytical and critical thinking skills for claims review and resolution
- High attention to detail and strong organizational skills
- Sound judgment and timely decision-making in handling escalations
- Professionalism, integrity, and ability to maintain confidentiality
- Strong written and verbal communication skills in English when dealing with internal teams, payers, and patients
Preferred Qualifications
- Experience with Athena EMR/EHR systems
- Experience working with small commercial payers (mom and pop insurers)
- Background in Workers Compensation and Employee Paid Services (EPS)
