US Eye Accounts Receivable (AR) Appeals Specialist

US Eye • Remote, FL, FL

2d • Hybrid

About The Position

The AR Appeals Specialist is responsible for managing denied insurance claims, preparing and submitting reconsiderations & appeals, and ensuring accurate reimbursement for healthcare services. This role requires strong analytical skills, knowledge of medical billing and coding, and the ability to navigate payer policies and systems.

Requirements

• High School Diploma or GED Required.

Nice To Haves

• Prior healthcare billing experience preferred.
• Certified Procedural Coder preferred.

Responsibilities

• Analyze denied claims to determine the reason for denial.
• Prepare and submit well-researched written appeals to insurance carriers.
• Review coding, contracts, and medical records to support appeals.
• Identify patterns and trends in denials to prevent future occurrences.
• Collaborate with upper management to present coding issues.
• Escalate unresolved denial issues and communicate payer policy changes.
• Track and follow up on reconsiderations and appeals within standard billing cycles.
• Stay current with payer guidelines, regulatory changes, and compliance standards.
• Document all actions taken on claims and appeals clearly and accurately.
• Participate in quality improvement initiatives and special projects.
• Communicate effectively with internal management, insurance companies, and patients.

Benefits

• 401(K) Company Match
• Medical and Dental Insurance
• Vision Benefits
• Flexible Spending

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED