AR Specialist - Clinical Denials

Job Summary

To support healthcare organizations, the full-time AR Specialist - Clinical Denials will manage complex clinical denials and appeals, verifying eligibility, updating patient information, and securing payments while working remotely.

Key responsibilities

• Verify eligibility and authorization, updating patient demographics and insurance information in relevant systems
• Research unpaid or denied claims, contacting payers to secure payment and submitting appeals as necessary
• Maintain confidentiality of patient information and adhere to state and federal claim guidelines while following productivity expectations

Required qualifications

• 2-3 years of experience in medical collections, denials, and appeals
• Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI coding
• Experience with various types of denials, including DRG downgrades and medical necessity issues
• Familiarity with third-party billing guidelines and billing claim forms (UB04/1500)
• Intermediate proficiency in Microsoft Word and Excel, along with health information systems