AR Follow-Up Specialist III - Coding and Complex Denials #Full Time #Remote

61st Street Service Corp•Fort Lee, NJ

20d•$28 - $36•Remote

About The Position

Top Healthcare Provider Network The 61st Street Service Corporation, provides administrative and clinical support staff for ColumbiaDoctors . This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties. This position is primarily remote, candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut). Note: There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs. Opportunity to grow as part of the Revenue Cycle Career Ladder! Job Summary: The AR Follow-Up Specialist III, Coding and Complex Denials is responsible for addressing and resolving complex coding-related denials and appeals in addition to following up on unpaid accounts with insurance companies and third parties. This role requires close collaboration with Certified Professional Coders (CPS) and other coding professionals to successfully appeal denied claims and ensure compliance with payer guidelines. The Specialist III assists the unit supervisor and manager with complex cases, supports training efforts, and identifies denial trends to inform process improvements. Professionalism and courteous communication are essential in all interactions.

Requirements

High school graduate or GED certificate is required.
A minimum of 2 years experience in a physician billing or third party payer environment.
Candidate must demonstrate the ability to understand and navigate contracts, insurance benefits, exclusions, and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate strong customer service and patient-focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process.
Must demonstrate effective communication skills both verbally and written.
Intermediate proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)

Nice To Haves

Experience in Epic and or other electronic billing systems is preferred.
Knowledge of medical terminology, diagnosis, and procedure coding is preferred.
Previous experience in an academic healthcare setting is preferred.

Responsibilities

Work closely with Certified Professional Coders (CPCs) to gather documentation, support appeals, and overturn coding-related denials effectively.
Elevate cases requiring advanced coding review to appropriate CPCs or supervisors as needed.
Prepare and submit appeals for denied claims, including Letters of Medical Necessity and other supporting documentation, in collaboration with coding professionals.
Address incoming correspondence related to coding denials and respond timely to ensure prompt resolution.
Identify patterns in coding-related denials and escalate trends to supervisors to improve processes and reduce future denials.
Provide input on process improvements and best practices to enhance the efficiency of denial management.
Assist Assistant Director/Supervisor with monitoring work queues and other assigned duties related to coding and denial follow-up.
Support the training of new hires, particularly on coding and complex denial workflows.
Contact insurance companies, patients, or account guarantors via phone, correspondence, and online portals to obtain the status of outstanding claims and submitted appeals.
Perform demographic and insurance coverage updates on accounts as appropriate, ensuring all corrections are properly documented and billed.
Address issues related to third-party sponsorship and follow up as needed.