ACCOUNTS RECEIVABLE SPECIALIST

PSN Services LLC•Plano, TX

14d

About The Position

The AR Specialist will oversee accounts receivable management and denial resolution for inpatient and outpatient procedures in spine, orthopedic, ENT, and pain management. This role is responsible for managing aging AR, investigating claim denials, and working closely with our external billing vendor to ensure timely follow-up and resolution. The ideal candidate will conduct in-depth, claim-level reviews to uncover root causes of nonpayment—such as coding issues, missing documentation, authorization gaps, or medical necessity requirements—and partner with internal teams to support appeals and implement corrective actions. This position is critical to driving cash flow performance and minimizing preventable write-offs across high-value procedural service lines.

Requirements

Excellent verbal and written communication skills.
Excellent interpersonal and customer service skills.
Excellent sales and customer service skills.
Excellent organizational skills and attention to detail.
Excellent time management skills with a proven ability to meet deadlines.
Strong analytical and problem-solving skills.
Strong supervisory and leadership skills.
Ability to prioritize tasks and to delegate them when appropriate.
Ability to function well in a high-paced and at times stressful environment.
Proficient with Microsoft Office Suite or related software.
Minimum 3–5 years of medical AR, denial management, or revenue cycle experience—preferably in spine, orthopedics, ENT, or pain management practices.
Proven experience reviewing eligibility, coding (CPT, ICD-10, HCPCS), modifiers, medical necessity, and authorization rules.
Strong understanding of payer denial codes, including CARC and RARC systems.
Skilled in analyzing aging accounts receivable, resolving underpayments, and advocating provider reimbursement.
Proficient with denial/claim management systems, practice management or EMR platforms, spreadsheets, and payer portals.
Exceptional analytical thinking, attention to detail, and effective communication with clinical, coding, and billing stakeholders.

Responsibilities

Research each claim, reviewing EOBs, provider notes, payer policies, and medical necessity guidelines.
Research each denied claim at the claim and line-item level — thoroughly review EOBs, payer denial data, medical documentation, provider notes, and applicable payer medical necessity guidelines.
Perform root cause analysis: dissect denials by CARC/RARC codes and identify underlying causes—coding issues (CPT/ICD‑10/modifiers), medical necessity criteria, authorization lapses, documentation deficiencies, timely filing, provider credentialing, etc.
Coordinate with billing vendors by communicating insights, denial issues, and additional documentation needs to vendor teams to facilitate corrected claim resubmission or appeal.
Monitor appeal outcomes and denial resolution by tracking status’ via vendor workflows, AR aging reports, and payer responses to ensure claims are resolved within allowable timeframes.
Identify and escalate trends: analyze denial pattern data across service lines, flag recurring root causes, and recommend systematic process improvements or training to mitigate future denials
Collaborate cross-functionally: work with RCM team members and vendor personnel to address documentation or coding gaps and implement preventive corrective actions
Maintain accurate logs of claim actions, denial codes, tasks, and outcomes; produce reports for leadership on denial trends and recovery performance.
Ensure compliance with HIPAA, payer regulations, and internal audit standards.