RCM AR Specialist

ALLERGY PARTNERS•Asheville, NC

About The Position

The RCM AR Specialist follows up on claim denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. Specialists are assigned a book of business based on financial class and payers, and support field teams with claim denials. The role follows up on denied claims and claims without a timely response, submits appeals for contract-rate variances, sends requested medical records, and monitors payer correspondence and field inquiries. It also involves contacting payers about unpaid claims that are 45 days old, documenting activity in the computer system, responding to written and telephone inquiries, and maintaining relationships with assigned carriers. The position has no supervisory responsibilities. The work is performed in a professional office environment. For remote work, functioning internet and participation in on-camera team calls are expected. Physical demands are moderate and include occasional lifting of approximately 20–30 pounds, prolonged sitting, some bending, stooping, and stretching, and operating office equipment. Occasional evening or weekend work may be required.

Requirements

High school diploma or GED equivalent.
Comfort using email and interacting with Internet applications.
Knowledge of practice management and Microsoft processing software.
Understanding of Explanation of Benefits forms, claim forms, and the insurance billing process.
Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.
Basic knowledge of CPT and ICD-10 coding.
Strong written and verbal communication skills.

Nice To Haves

College education or trade school.
Previous medical billing and collections experience.
A minimum of eighteen months of experience is preferred.

Responsibilities

Follow up on denied claims and claims that have not received a response within a timely manner.
Submit appeals for contract-rate variances involving discrepancies in allowed amounts and notify the Supervisor when payer issues are recurring.
Submit medical records requested by payers for claim processing determinations.
Monitor and review payer correspondence received through the lockbox and faxes.
Monitor, review, and respond to Hub (field) communication inquiries within the 48-hour requirement.
Use monthly aged accounts receivable reports to contact payers or check claim status online for unpaid insurance claims that are 45 days old, and record responses or activity in system notes.
Respond to written and telephone inquiries from insurance companies.
Build and maintain relationships with personnel from assigned carriers.
Meet regularly with the Pod Lead or Supervisor to discuss and resolve reimbursement and insurance follow-up concerns.
Maintain detailed knowledge of practice management and other computer software relevant to job functions.
Attend meetings as requested, including regular staff meetings.
Attend Medicare and other continuing education courses as requested, and pursue education to remain current with healthcare industry changes.
Perform additional duties as requested by RCM Leadership.
Complete assigned AP training, such as CPR, OSHA, HIPAA, Compliance, and Information Security, within designated timeframes.
Comply with company and hub/department policies, report policy violations through the designated channels, and model the AP Code of Conduct and commitment to the Compliance Program.