Ar Specialist Jobs

About The Position

Requirements

• High school diploma or equivalent required.
• Minimum of three years of insurance billing experience or CPC certification required.
• Must demonstrate current competencies applicable to the position and have proven experience performing required tasks independently while contributing to a team environment.
• Must maintain knowledge of medical terminology, CPT coding, ICD-10 coding, and insurance regulations.
• Strong organizational and customer service skills are essential.
• Previous experience working in a high-volume, fast-paced environment is required, along with demonstrated self-motivation to develop and maintain the knowledge and skills necessary for success in the role.

Nice To Haves

• CPC, CCA, RHIA, or RHIT certification in medical billing and coding preferred.
• Associate degree preferred.

Responsibilities

• Identifies and evaluates denials for assigned payers and/or specialties to determine specific issues and patterns that need to be addressed.
• Serves on Denial Task Forces and assists in developing action plans to reduce denials and streamline clean claim submissions.
• Exports data, prepares spreadsheets, and creates and runs reports used in resolving outstanding claims, including trending reports, special projects, and worklists.
• Identifies trends and provides follow-up for claims requiring correction or appeal.
• Demonstrates proficiency in analyzing complex billing problems, preparing appeals, challenging payer policies, and pursuing appeal turnover when necessary.
• Works with the team and department management to develop and train staff on internal rejection protocols.
• Maintains current knowledge of coding requirements, reimbursement policies, payer guidelines, and industry best practices.
• Ensures staff adherence to protocols through auditing and education.
• Identifies and promptly reports payer, system, or billing issues.
• Works with the Applications Analyst, Supervisor, Manager, and Director to provide recommendations and support resolution efforts.
• Works with the team and payers to ensure timely resolution of assigned credit balances.
• Assists with preparation of annual escheatment documentation.
• Leads payer-specific external claim audit activities in collaboration with Management, Compliance, Medical Records, and Clinical Operations.
• Serves as a group leader by performing one or more of the following duties: Employee training, Routing work assignments, Participation in employment-related issues.
• Reviews requested adjustments from Specialists and approves low-dollar adjustments within policy guidelines.
• Collects information and supporting documentation for Director approval of high-dollar adjustments.
• Performs testing and monitoring of new system logic and processes with the Business Analyst and/or Manager.
• Answers phone calls and correspondence, providing requested information to assist in resolving account balances.
• Maintains knowledge of and performs duties in compliance with Guthrie Medical Group and payer guidelines.
• Provides feedback related to workflow processes to promote efficiency.
• Utilizes Epic system functions accurately to perform assigned tasks, including: Charge corrections, Invoice inquiries, Credits, Charge review, Claim edits, 277 rejections, Related billing functions.
• Trains staff on these functions as needed.
• Demonstrates excellent customer service skills for both internal and external customers while promoting the same within the team environment.
• Maintains strict confidentiality of patient health information in accordance with HIPAA regulations.
• Assists with and completes special projects and other duties as assigned.

Benefits

• Voluntary 403(b) Retirement Plan with Fidelity investment options
• Employee Assistance Program providing confidential support for personal and professional well-being
• PTO starts Day 1