A/R Specialist

WellStreet Urgent Care•Newnan, GA

About The Position

The A/R Specialist is responsible for insurance account follow-up, denial management, and claim resolution activities to support timely and accurate reimbursement. This position focuses on researching and resolving insurance denials, payer rejections, unpaid claims, and reimbursement issues while ensuring appropriate documentation and follow-up is completed.

Requirements

Strong knowledge of the healthcare revenue cycle, including insurance claim processing, A/R follow-up, denial management, appeals, and reimbursement processes.
Knowledge of payer guidelines, denial reason codes, claim edits, and insurance reimbursement requirements.
Ability to analyze and resolve complex insurance claim issues.
Knowledge of medical terminology, CPT/HCPCS, ICD-10 coding concepts, and billing practices.
Experience interpreting EOBs, remittance advice, and payer correspondence.
Strong computer skills, including proficiency with Microsoft Office Suite (Word, Excel, and Outlook).
Experience navigating payer portals and healthcare billing systems.
Excellent organization, documentation, and communication skills.
Strong attention to detail with the ability to manage multiple accounts and priorities.
Ability to work independently and meet productivity and quality expectations in a fast-paced environment.
Positive attitude, dependability, flexibility, and ability to work effectively within a team environment.

Nice To Haves

3+ years of experience in medical billing, insurance A/R follow-up, denial management, or healthcare revenue cycle preferred.
Experience working insurance denials, claim resolution, appeals, and payer follow-up preferred.
Knowledge of commercial insurance, Medicare, Medicaid, and other third-party payer processes.
Experience with outpatient or urgent care billing preferred.
Experience with Epic or other electronic medical record/practice management systems preferred.

Responsibilities

Perform insurance A/R follow-up to identify, research, and resolve outstanding claim balances.
Manage assigned insurance A/R work queues and prioritize accounts based on payer requirements, aging, and reimbursement goals.
Review and resolve insurance claim denials, rejections, and unpaid claims to maximize reimbursement.
Research denial reasons, payer responses, and claim history to determine appropriate resolution.
Complete required follow-up actions, including claim corrections, resubmissions, reconsiderations, and appeals.
Complete daily review and resolution of front-end payer rejections, including researching claim edit issues, making necessary corrections, and submitting claims for processing.
Analyze explanation of benefits (EOBs), remittance advice, and payer correspondence to determine next steps for claim resolution.
Follow up with insurance carriers regarding claim status, denials, payment discrepancies, underpayments, and outstanding balances.
Identify trends related to denials, payer issues, and claim processing errors and communicate opportunities for improvement.
Research and resolve claim issues related to eligibility, authorization, coding, billing, and payer requirements.
Utilize payer portals, Epic, billing systems, and other revenue cycle tools to complete account follow-up activities.
Maintain accurate and timely documentation of all account activity, payer communication, and resolution efforts.
Escalate complex payer issues appropriately and provide recommendations for resolution.
Assist with other revenue cycle activities as assigned.