AR Specialist, Physician Billing
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Job Description
Revenue Cycle Specialist managing claims, denials, and AR for Infinx’s healthcare revenue-cycle technology services. Working directly in payer and client billing systems to improve reimbursements.
Responsibilities:
- Work across eligibility, demographics, billing, edit resolution, AR follow-up, and denial management
- Verify insurance coverage and benefits using payer portals, EDI 270/271 transactions, and payer outreach
- Determine primary, secondary, and tertiary payer order
- Identify prior authorization, pre-certification, referral, Medicare Secondary Payer, workers’ compensation, motor vehicle accident, and third-party liability scenarios
- Review and correct patient, guarantor, subscriber, and insurance data in EHR, PMS, or registration systems
- Submit clean claims directly to Medicare DDE/FISS, state Medicaid portals, and payer-specific channels
- Resolve claim edits, scrubber rejections, and pre-submission errors
- Correct UB-04 and CMS-1500 claim data, including codes, modifiers, place of service, and provider information
- Work aged accounts receivable and prioritize high-dollar and high-aging balances
- Contact payers to determine claim status and resolve denial or pending reasons
- Research and resolve denials and underpayments through rebilling, reconsiderations, appeals, corrected claims, and medical-record submissions
- Prepare and submit written appeals with supporting documentation
- Identify and pursue underpayments against expected contract terms
- Manage payer follow-up across Medicare, Medicaid, commercial, managed care, workers’ compensation, TRICARE, and VA
- Analyze rejection and denial trends and escalate data-driven recommendations
- Collaborate with coding, charge capture, patient access, HIM, and client-side teams
- Document account activity in source systems
- Maintain productivity, quality, HIPAA, payer, CMS, and billing-regulation standards
Requirements:
- High School Diploma or GED
- 3-5 years of hospital and/or physician revenue cycle experience in at least two focal areas
- Hands-on experience submitting claims directly to payers via Medicare DDE/FISS, state Medicaid portals, and/or payer-specific direct submission channels
- Demonstrated ability to work natively in client EHR, PMS, and billing systems
- Comprehensive knowledge of UB-04 and CMS-1500 claim forms, revenue codes, CPT/HCPCS, ICD-10-CM, and modifier usage
- Expertise in Medicare, Medicaid, TRICARE, VA, and commercial payer processes
- Working knowledge of NCCI edits, MUE edits, LCD/NCD policy logic, and bundling rules
- Hands-on experience with major payer portals and EDI 270/271 eligibility transactions
- Knowledge of coordination of benefits, payer determination, and Medicare Secondary Payer rules
- Ability to interpret EOBs, remittance advices, contracts, and payment documentation
- Solid Excel skills, including filtering, sorting, pivot tables, and basic formulas
- Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations
- Ability to prioritize workload and manage multiple responsibilities
- CRCR or CRCS certification preferred
- 6+ years of cross-functional hospital revenue cycle experience preferred
- Experience with Medicare FISS/DDE adjustment workflows preferred
- Familiarity with UB-04 and CMS-1500 claim types preferred
- Bilingual English/Spanish preferred
Benefits:
- Access to a 401(k) Retirement Savings Plan
- Comprehensive Medical, Dental, and Vision Coverage
- Paid Time Off
- Paid Holidays
- Pet Care Coverage
- Employee Assistance Program (EAP)
- Discounted services
- Flexible work hours when possible
- Dynamic and inclusive workplace culture
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