Accounts Receivable (A/R) and Denial Management Specialist

New

RCM Staff BPOHealthcare revenue cycle

Source API remote eligibility restrictions: United States, Must be available during Eastern Time business hoursFull-TimeJunior

Salary not disclosed

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Job Details

Languages: Strong written and spoken English
Experience: At least 2 years of experience with U.S. healthcare A/R follow-up and denial management
Required Skills: HIPAA

Have at least 2 years of experience with U.S. healthcare A/R follow-up and denial management.
Have experience reviewing claims for accuracy and resolving eligibility and payer errors.
Be familiar with commercial insurance and government health plans, including Medicare.
Have experience using payer portals and insurance websites.
Have strong written and spoken English.
Demonstrate attention to detail and follow-up skills.
Be able to work independently and manage multiple patient accounts.
Have a reliable internet connection and suitable remote workspace.
Be available during Eastern Time business hours.
AdvancedMD experience is preferred.
Experience with First Coast SPOT, Availity, and the UnitedHealthcare provider portal is preferred.
Experience supporting internal medicine, hospitalist, wound care, or pain management practices is preferred.
Familiarity with Florida insurance plans and Medicare reconsiderations and redeterminations is preferred.

Review pending and unbilled claim buckets in the practice management system for accuracy before submission.
Correct eligibility, wrong-payer, demographic, and coding-related errors.
Verify patient eligibility and confirm primary and secondary insurance.
Follow up on unpaid, underpaid, and aged claims through payer portals and phone calls.
Research denials and submit corrected claims, reconsiderations, or appeals.
Check claim status and resolve issues using Medicare, Availity, and UnitedHealthcare portals.
Document follow-up activity and next steps in the practice management system.
Report recurring denial trends and payer issues to the billing manager.
Work with the practice’s in-house A/R team and meet daily productivity targets.
Protect patient information and follow HIPAA requirements.

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