AR Specialist
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Job Description
Medical A/R Revenue Specialist managing denials, aging follow-up, payment reconciliation, and payer communication. Supporting Capitol Imaging Services’ healthcare billing and revenue integrity.
Responsibilities:
- Partner with external billing vendors to address claim rejections and payer requests for clarification
- Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions
- Review escalated accounts requiring internal oversight or final resolution
- Identify denial trends, recurring payer issues, and root causes
- Provide feedback and strategic direction on appeal approaches and payment resolution tactics
- Authorize final adjustments after appeal opportunities have been exhausted, ensuring documentation and compliance
- Recommend process improvements to reduce future denials
- Work A/R aging reports for 30, 60, and 90+ day accounts to identify unpaid or underpaid claims
- Initiate payer tracers and follow-ups to secure claim adjudication and payment
- Monitor high-risk and high-dollar accounts to prevent revenue leakage
- Post and reconcile insurance and patient payments accurately
- Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy
- Assist with account reconciliations and discrepancy resolution
- Liaise with patients and insurance payers to resolve billing questions
- Explain EOBs, patient responsibility, and out-of-pocket costs
- Conduct professional and empathetic phone communication with patients and payer representatives
Requirements:
- High School Diploma or equivalent required
- Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred
- 1–3 years of experience in medical billing and collections, Accounts Receivable or Revenue Cycle Management, or healthcare payer follow-up and denial resolution
- Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)
- Strong working knowledge of Microsoft Office, particularly Excel (reports, aging analysis) and SharePoint
- Working knowledge of medical terminology, CPT and ICD-10 coding, and payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans
- Strong analytical and problem-solving skills
- Exceptional attention to detail and accuracy
- Effective written and verbal communication skills
- Ability to work collaboratively with internal teams and external vendor partners
- Sound judgment related to financial adjustments and account resolution
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