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 specific book of business based on financial class and payers and support the field with claim-denial matters. The position reports to the RCM Supervisor, AR Collections, and has no supervisory responsibilities. The role works with insurance payers to investigate unpaid claims, handle appeals and requested medical records, review payer correspondence, and respond to inquiries from field teams. It requires maintaining accurate account notes, familiarity with practice-management and other relevant software, and professional working relationships with assigned carriers. The specialist also participates in meetings and continuing education, completes required training, and follows organizational policies and compliance standards. The work is performed in a professional office environment. If working remotely, the employee must have functioning internet and be available for on-camera team calls. Physical demands are moderate and include prolonged sitting, occasional bending, stooping, stretching, and occasional lifting of items weighing approximately 20–30 pounds. Occasional evening or weekend work may be required. Compensation may vary based on geographic location and job-related knowledge, skills, and experience.

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.
Ability to meet the role's physical demands, including prolonged sitting and occasional lifting of approximately 20–30 pounds.
If remote, functioning internet and availability for on-camera team calls.

Nice To Haves

College education or trade school.
Previous medical billing and collections experience; preference for at least 18 months of experience.

Responsibilities

Follow up promptly on denied claims and claims that have received no response.
Submit appeals for contract-rate variances involving discrepancies in allowed amounts and notify the Supervisor about payers for which the issue is recurring.
Submit medical records when requested by payers to determine claim processing.
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 the computer 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 as it relates 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 Allergy Partners and applicable hub or department policies; report policy violations to a Supervisor, Manager, Director, the Department of Compliance & Privacy, or the AP EthicsPoint hotline.
Model the AP Code of Conduct and demonstrate commitment to the AP Compliance Program, standards, and policies.