Medical A/R Specialist

TEKsystems•South Miami, FL

4d•$24 - $26•Onsite

About The Position

Review and resolve missing or inaccurate claim information to ensure timely claim submission. Manage assigned billing work queues and submit clean, accurate claims. Resolve claim edits, denials, underpayments, and outstanding A/R balances using available tools and resources. Review claims and supporting documentation for billing and coding accuracy. Prepare and submit appeals, track outcomes, and maintain compliance with payer and HIPAA requirements. Analyze EOBs and ERAs to identify reimbursement discrepancies, denial trends, and payment issues. Apply payer guidelines and contract terms when addressing reimbursement and denial issues. Escalate reimbursement, credentialing, contractual, and system-related issues as appropriate. Monitor claims to ensure filing deadlines are met and claims are processed in a timely manner. Maintain compliance with all payer, regulatory, and organizational billing requirements. Collaborate with cross-functional teams to resolve pending or missing claim information. Provide coverage across billing queues and assist with special projects as needed.

Requirements

Associate degree preferred or equivalent work experience.
3-5 years of healthcare billing, accounts receivable, or revenue cycle experience.
Managed Care/HMO contract billing experience required.
Strong understanding of CMS-1500 and/or UB-04 claim forms for hospitals and diagnostic facilities.
Experience working denials, appeals, underpayments, and claim follow-up.
Knowledge of medical terminology, revenue cycle operations, and reimbursement methodologies.
Working knowledge of ICD-10, CPT-4, HCPCS, modifiers, revenue codes, and payer billing guidelines.
Understanding of HIPAA regulations and healthcare compliance requirements.
Experience reviewing EOBs and ERAs and interpreting reimbursement outcomes.
Proficiency with Microsoft Office Suite and healthcare billing systems.
Strong analytical, critical-thinking, and problem-solving skills.
Excellent verbal and written communication skills.
Ability to manage high-volume workloads, prioritize tasks, and meet strict deadlines.
Detail-oriented with strong organizational and time-management abilities.

Nice To Haves

Coding certification (CPC, CPC-H, CCS, or RMC) preferred but not required.
Experience with collections, refunds, claim adjudication, and federal healthcare programs is a plus.

Responsibilities

Review and resolve missing or inaccurate claim information to ensure timely claim submission.
Manage assigned billing work queues and submit clean, accurate claims.
Resolve claim edits, denials, underpayments, and outstanding A/R balances using available tools and resources.
Review claims and supporting documentation for billing and coding accuracy.
Prepare and submit appeals, track outcomes, and maintain compliance with payer and HIPAA requirements.
Analyze EOBs and ERAs to identify reimbursement discrepancies, denial trends, and payment issues.
Apply payer guidelines and contract terms when addressing reimbursement and denial issues.
Escalate reimbursement, credentialing, contractual, and system-related issues as appropriate.
Monitor claims to ensure filing deadlines are met and claims are processed in a timely manner.
Maintain compliance with all payer, regulatory, and organizational billing requirements.
Collaborate with cross-functional teams to resolve pending or missing claim information.
Provide coverage across billing queues and assist with special projects as needed.