AR Specialist

Job Details: - Job Location: Remote - Capitol Billing Group - Metairie, LA - Position Type: Full Time - Salary Range: Undisclosed - Job Shift: Day Medical Accounts Receivable (A/R) Revenue Specialist Position Summary The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.

Key Responsibilities

Claims & Vendor Management - 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. Denial Management & Appeals - Collaborate with vendor partners to 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 all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance. - Recommend process improvements to reduce future denials. Accounts Receivable Follow-Up - Proactively work A/R aging reports (30, 60, 90+ days) 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. Payment Posting & Reconciliations - Ensure accurate posting and reconciliation of insurance and patient payments. - Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy. - Assist with account reconciliations and discrepancies resolution as needed. Patient & Insurance Communication - Act as a liaison between patients and insurance payers to resolve billing questions. - Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs. - Conduct professional and empathetic phone communication with patients and payer representatives. Qualifications & Requirements Education - High School Diploma or equivalent required - Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred Experience - 1–3 years of experience in: - Medical billing and collections - Accounts Receivable or Revenue Cycle Management - Healthcare payer follow-up and denial resolution Technical Skills - Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR) - Strong working knowledge of Microsoft Office, particularly: - Excel (reports, aging analysis) - SharePoint Medical & Regulatory Knowledge - Working knowledge of: - Medical terminology - CPT and ICD-10 coding - Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans Core Competencies - 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 Qualifications: