AR Specialist

Job Summary

We seek candidates to join our organization as
Accounts Receivable (AR) Specialists
for night shift operations. The AR Specialist is responsible for managing the reimbursement process of medical claims, focusing on follow-up, collections, denial resolution, and account reconciliation. This role requires strong knowledge of US healthcare payer policies, attention to detail, and experience working with billing/RCM systems. The ideal candidate ensures timely recovery of outstanding balances while maintaining compliance with healthcare regulations and payer requirements.

Key Responsibilities

• Claims Follow-up:
  Track and follow up on unpaid, denied, or underpaid claims with insurance companies, Medicare/Medicaid, and other third-party payers.
• Denial Management:
  Analyze reasons for claim denials or rejections, initiate appeals, and resubmit claims as needed.
• Payment Posting & Reconciliation:
  Post payments, adjustments, and denials in the billing system; reconcile balances to ensure accuracy.
• AR Aging Management:
  Review aging reports, prioritize accounts, and take necessary actions to reduce outstanding AR days.
• Payer Communication:
  Contact insurance companies via phone, portals, or written correspondence to resolve claim issues and secure payments.
• Patient Balance Management:
  Assist with patient billing inquiries, set up payment plans, and escalate unresolved issues.
• Compliance:
  Ensure all AR activities comply with payer rules, federal/state regulations, and HIPAA guidelines.
• Reporting:
  Generate and analyze AR reports to track collections performance, identify trends, and support management with insights.
• Collaboration:
  Work with billing, coding, and provider teams to resolve claim discrepancies and ensure complete reimbursement.
• Dispute Resolution:
  Investigate and resolve discrepancies in payments or adjustments by coordinating with payers and internal teams.

Qualifications

• Experience:
  Minimum 1+ years of experience in Accounts Receivable, Claims Follow-up, or Denial Management within US healthcare RCM.
• Knowledge:
  Strong understanding of payer processes, EOBs, denials, appeals, and AR cycle in US healthcare.
• Technical Skills:
  Proficiency with practice management systems/RCM platforms (Athena, eClinicalWorks, Epic, etc.) and MS Office (Excel, Word).
• Communication Skills:
  Strong verbal and written skills for interacting with payers, patients, and internal stakeholders.
• Analytical & Problem-Solving:
  Ability to analyze denial patterns, troubleshoot issues, and recommend process improvements.
• Attention to Detail & Organization:
  High accuracy in payment posting, account review, and AR reconciliation in a fast-paced environment.

Preferred Skills

• Experience with
  Medicare, Medicaid, and major commercial payers
  (Aetna, Cigna, BCBS, UHC).
• Familiarity with
  appeals and reconsideration processes
  for denied claims.
• Exposure to
  RCM KPIs
  such as AR days, denial rate, and collection efficiency.
• Experience working in a
  BPO/KPO healthcare setting
  or US-based RCM company.