AR Claims Specialist II
About The Position
This role plays a key part in the revenue cycle by researching claim issues, resolving billing errors, and ensuring compliance with payer and regulatory requirements. The AR Claims Specialist II also serves as a subject-matter resource for assigned payers and supports team training and process improvement efforts. The AR Claims Specialist contributes directly to the financial health of YVFWC by ensuring claims are processed correctly and reimbursed in a timely manner. Through diligent follow-up, payer expertise, and collaboration with billing and revenue cycle partners, this role helps reduce denials, improve workflows, and support YVFWC’s mission. Be part of a healthcare organization that believes in making a difference beyond medical care! We've transformed into a leading community health center in the Pacific Northwest with 40+ clinics across Washington and Oregon. We offer a wide range of services such as medical, dental, pharmacy, orthodontia, nutritional counseling, autism screening, and behavioral health. Our holistic model also extends assistance to shelter, energy, weatherization, HIV and AIDS counseling, home visits, and mobile medical/dental clinics.
Requirements
- High School diploma or GED
- 3 years of previous medical billing with third party and Medicare/Medicaid experience required
- Certified Revenue Cycle Representative (CRCR) certification required
- Completion of HFMA courses Strategies to Prevent Claim Denials or Best Practice (Patient Centric) Revenue Cycle Overview within 180 days of hire
- Strong attention to detail, analytical skills, and ability to meet deadlines
- Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)
- Maintain consistent performance and attendance standards
- Strong written and verbal communication skills
Nice To Haves
- Experience with EPIC system and FQHC billing and/or coding preferred
- Strong customer relations skills preferred
- Knowledge of medical/dental terminology, data entry, and billing coding preferred
- Knowledge of accounts receivable processes preferred
Responsibilities
- Process third-party claims in a timely and accurate manner, resolving claim edits and resubmitting corrected claims as necessary
- Provide required documentation in account notes and participate in developing standard texts for account documentation
- Maintain Epic Claims work queues according to daily department standards and research causes of repeated errors, addressing solutions through feedback loop processes
- Reconcile daily claim volume balances using information from Epic and claims clearinghouse reports
- Actively works with intra-department leadership to create compliant, automated processes within Epic and the claims clearinghouse
- Actively stay abreast of all payor billing changes and requirements, becoming the subject-matter expert for assigned payors
- Responsible for informing revenue cycle counterparts of coding or other billing changes implemented by the assigned payor
- Maintain daily balance logs of claims sent from the EMR to the clearinghouse to ensure all claim runs are balanced daily
- Train new AR Claims staff when called upon
- Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
- Participate in the development of claims education and procedure documentation
- Maintain confidentiality of all patient demographic, medical, and financial information at all times
- Perform other duties as assigned
Benefits
- 100% employer-paid health insurance, including medical, dental, vision, Rx, 24/7 telemedicine
- Profit sharing & 403(b) retirement plan available
- Generous PTO, 8 paid holidays, and much more!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
