PB & HB Coding Denials & Edits Specialist (AAPC or AMHIMA cert required)

CorroHealth•TX-Remote, TX

About The Position

Reporting to the Manager, AR Services, the AR Specialist is responsible for timely collection of outstanding government or commercial healthcare insurance receivables. The role follows up on outstanding accounts receivable for payers, including self-pay accounts, and resolves denials. The company describes its purpose as helping clients exceed their financial health goals through reimbursement-cycle solutions, clinical expertise, technology, and analytics, and emphasizes investment in employees’ professional development and personal growth. The specialist interacts with insurance plans, patients, physicians, attorneys, and coworkers as needed. The position includes verifying eligibility and authorization, updating patient and insurance information, researching unpaid or denied claims, contacting payers to secure payment, processing denials and code edits, preparing technical appeals, investigating underpayments, and preparing certain denied claims for clinical audit processing. The role follows prioritization, timely filing, and documentation protocols and obtains medical documentation and billing guidance as needed.

Requirements

At least 3 years of accounts receivable experience within the healthcare revenue cycle.
AAPC or AHIMA certification, such as CPC or RHIT.
At least 2 years of experience with healthcare and/or insurance billing and processing.
Experience with professional physician and hospital facility claims.
Ability to read and interpret an EOB.
Knowledge and understanding of UB-04 and HCFA 1500 forms.
High school diploma.
Proficiency with Outlook, Excel, and Word, including managing email, calendar, and tasks and using basic formulas.
Ability to communicate professionally and clearly.
Strong interpersonal skills.
Ability to work independently and apply analytical and critical-thinking skills.

Responsibilities

Interact with insurance plans, patients, physicians, attorneys, and fellow team members as needed.
Verify or obtain patient eligibility and authorization for healthcare services through payer websites, client eligibility systems, or phone conversations with insurers or healthcare providers.
Update patient demographics and insurance information in appropriate systems.
Research and appropriately status unpaid or denied claims.
Monitor claims for missing information, authorization, and control numbers (ICN/DCN).
Research EOBs for payments or adjustments to resolve claims.
Contact payers by phone or written correspondence to secure payment of claims.
Access client systems for payment, open-claim, and other information needed to resolve claims.
Follow guidelines for prioritization, timely filing deadlines, and notation protocols in appropriate systems.
Secure medical documentation as required or requested by third-party insurance carriers.
Research provider billing manuals to obtain billing guidelines and requirements.
Work denials and code edits.
Write appeal letters for technical appeals.
Verify the accuracy of underpayments by researching contracts and claims data.
Prepare claims for clinical audit processing in cases involving authorization, coding, level-of-care, or length-of-stay denials.