AR Specialist/Denial Manager

Job Summary
We are seeking a detail-oriented and proactive Claims Specialist to join our team. The ideal candidate will manage the entire claims appeal and resolution process, ensuring timely and accurate submission and follow-up of insurance claims. This role requires strong analytical skills to resolve denied claims and billing discrepancies, as well as excellent communication abilities to coordinate with insurance providers and internal teams. The Claims Specialist will play a critical role in optimizing revenue cycle processes and reducing claim denials.

Key Responsibilities
- Manage the claims appeal and resolution process from initiation through final resolution, ensuring all appeals are handled efficiently and effectively.
- Complete accurate and timely submission of claims to the appropriate insurance payers, adhering to payer-specific guidelines and requirements.
- Submit billing data to insurance providers, ensuring all information is complete and compliant with billing standards.
- Analyze denied claims to identify root causes and implement corrective actions to resolve billing issues promptly.
- Monitor the aging of claims regularly to ensure timely follow-up, preventing delays and minimizing future denials.
- Ensure accurate payment processing by verifying payments received and escalating unresolved payment issues to management for further action.
- Conduct insurance re-verification using various tools and resources to confirm patient eligibility and coverage before billing.
- Initiate billing to new payers, reprocess claims as necessary, or bill patients directly when insurance coverage is unavailable or insufficient.
- Effectively multitask and manage time to handle multiple claims and billing activities simultaneously without compromising accuracy or deadlines.
- Demonstrate excellent written and verbal communication skills to interact professionally with insurance representatives, patients, and internal stakeholders.
- Exhibit strong problem-solving skills and organizational abilities to manage complex billing scenarios and maintain accurate records.

Required Qualifications
- Proven experience in claims processing, billing, or a related healthcare revenue cycle function.
- Solid understanding of insurance claim submission processes and payer requirements.
- Ability to analyze and resolve denied claims and billing discrepancies efficiently.
- Proficiency in using insurance verification tools and billing software.
- Strong organizational skills with the ability to manage multiple priorities and meet deadlines.
- Excellent communication skills, both written and verbal, to effectively liaise with insurance providers and internal teams.
- Detail-oriented with a commitment to accuracy in all aspects of claims handling and billing.
- Demonstrated problem-solving skills to address and resolve complex billing issues.

Preferred Qualifications and Benefits
While not explicitly stated, candidates with experience in healthcare billing systems, knowledge of medical coding, or familiarity with specific insurance payer platforms will be at an advantage. Benefits typically include opportunities for professional development, a collaborative work environment, and competitive compensation aligned with industry standards.

This role offers a valuable opportunity for professionals looking to advance their career in healthcare revenue cycle management by contributing to efficient claims processing and resolution. If you are a motivated individual with a strong attention to detail and excellent communication skills, we encourage you to apply.