AR Specialist (51204)

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