AR Specialist 3

Methodist Health System•Dallas, TX

About The Position

This role involves developing, implementing, and facilitating a claims training program with a focus on appeals and denials. The specialist will need in-depth knowledge of the insurance industry and a proven ability to train employees in a fast-paced environment. The position is crucial for securing reimbursement and minimizing organizational write-offs. The Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare, operating a network of 12 hospitals and more than two dozen clinics. It is recognized as an award-winning employer.

Requirements

Subject matter expert with a complete understanding of professional billing.
In-depth knowledge in the insurance industry.
Proven ability to train employees in a fast paced environment.
Understanding knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes.
Complete understanding of the revenue cycle process to include prior authorization, billing, insurance appeals, and physician billing collection.
An Associate Degree in Accounting, Finance or Business Administration or equivalent experience in the Healthcare Industry.

Nice To Haves

Professional Certification through AAHAM, HFMA, or EPIC

Responsibilities

Develop, implement, and facilitate a claims training program with an emphasis on appeals and denials.
Maintain working knowledge of all departmental workflows and processes, applicable insurance carriers’ timely filing deadlines, claims submission and resubmission processes, and appeal processes.
Lead the development, implementation, and continuous improvement of claims training curriculum and education initiatives.
Collaborate with managers and team leads to identify workflow gaps, develop AR follow-up policies and procedures, and ensure they are accurately reflected in training manuals.
Schedule and conduct comprehensive department training sessions.
Create and continuously update training resources and documentation.
Collaborate with team leads, claims staff, and cross-departmental team members to enhance the quality and relevance of training materials.
Provide denial and payer related issue trends to leadership for escalation of data to payer relations team.
Support department leadership through research, analysis, and special project assistance.
Actively participate in huddle meetings and share detailed case insights.
Provide ongoing coaching and refresher training to ensure team adherence to standards, regulations, and best practices.
Train new employees and teach strategies for prioritizing cases, reviewing account history, remit, and payer history to determine the appropriate challenge and appeal strategy.
Apply prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary.
Promote collaborative teamwork and proactively suggest procedural improvements to management to enhance departmental efficiency and effectiveness.
Communicate clearly and openly.
Be accountable for your performance.
Take initiative for your professional growth.
Be engaged and eager to build a winning team.