A/R Billing Specialist - Atlanta, GA

PhyNet Dermatology LLC; Atlanta (GA); Hybrid; USD 40,000 - 70,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Billing Specialist to join their dynamic team. This role is essential for ensuring timely claims resolution and compliance with payer guidelines. The ideal candidate will excel in insurance follow-up, denials management, and claims resolution, showcasing strong attention to detail and excellent communication skills. With a hybrid work schedule, you will have the opportunity to work on-site and remotely, making it a flexible and rewarding position. If you are proactive, dependable, and committed to operational excellence, this is the perfect opportunity for you.

Qualifications

• Experience in denials management and insurance claims follow-up required.
• Strong understanding of payer guidelines and appeals processes.

Responsibilities

• Monitor claims for timely follow-up and resolution.
• Maintain comprehensive understanding of payer guidelines.
• Initiate and manage appeals to insurance companies.

Skills

Insurance Follow-up

Denials Management

Claims Resolution

Attention to Detail

Communication Skills

CPT/ICD-9/10 Coding

Education

High School Diploma

Certification in Medical Billing

Tools

Electronic Filing Systems

Job description

PhyNet Dermatology is seeking skilled and motivated Billing Specialists to join our team. If you excel at insurance follow-up, denials management, and claims resolution, we encourage you to apply today. As a Denials Specialist, you will play a critical role in ensuring timely claims resolution and maintaining compliance with payer guidelines.

Location:

Atlanta, GA

Hybrid Work Schedule
Work on-site Monday through Wednesday and remotely Thursday and Friday.

Essential Functions:

To perform effectively in this role, the candidate must fulfill the following duties with or without reasonable accommodations.

• Monitor commercial, government, and specialty payer claims to ensure timely follow-up and resolution.
• Maintain a comprehensive understanding of payer guidelines, policies, and requirements related to denials and appeals.
• Update demographic and account information as needed to ensure clean claim submissions.
• Meet or exceed productivity and accuracy benchmarks set by management.
• Review medical records, provider notes, and Explanation of Benefits (EOBs) to facilitate appeals or resolve accounts.
• Initiate and manage appeals to insurance companies to resolve claims effectively.
• Handle payer correspondence, ensuring all required information is submitted promptly for claim processing.
• Analyze claim coding (CPT, ICD-9/10, HCPCS) to ensure accurate billing practices.
• Conduct detailed account follow-ups, analyze problem accounts, and document resolution efforts.
• Audit accounts for payment accuracy, contractual adjustments, and patient balances.
• Identify and report payer trends or recurring issues to management for resolution.
• Collaborate with patients, physician offices, and insurance companies to obtain additional information for claim processing.
• Generate patient responsibility statements and utilize insurance websites to address and resolve claims.
• Ensure proper documentation of all follow-up actions in the accounts receivable system.
• Maintain regular attendance and demonstrate a strong commitment to teamwork and professionalism.

Knowledge, Skills & Responsibilities:

• Prior experience in denials management and insurance claims follow-up.
• Hands-on knowledge of HCFA billing and EOB review.
• Familiarity with payer requirements, denial workflows, and appeals processes.
• Proficiency in electronic filing systems and general computer skills.
• Strong attention to detail with the ability to identify and resolve issues accurately.
• Excellent verbal and written communication skills, with a professional and courteous demeanor.
• Demonstrated ability to meet productivity expectations while maintaining high-quality work.
• In-depth understanding of CPT/ICD-9/10 and HCPCS coding.

This role requires a proactive, dependable, and detail-oriented individual with the ability to manage multiple tasks in a dynamic healthcare environment. The ideal candidate demonstrates a strong commitment to patient care and operational excellence.

Physical and Mental Demands:

The physical and mental demands described below are representative of those required to perform this job successfully. Reasonable accommodations may be made for individuals with disabilities:

• Physical Requirements:
• Occasionally required to stand, walk, and sit for extended periods.
• Use hands to handle objects, tools, or controls; reach with hands and arms.
• Occasionally required to climb stairs, balance, stoop, kneel, bend, crouch, or crawl.
• Occasionally lift, push, pull, or move up to 20 pounds.
• Vision Requirements:
• Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Note:
This job description is intended to provide a general overview of the role. Additional responsibilities may be assigned, or duties modified by the department supervisor based on operational needs.

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