A/R & Denial Management Specialist

Rcmbilling; United States; Sur place; USD 65 000 - 85 000; Plein temps

Résumé du poste

Rcmbilling is seeking an experienced US healthcare AR follow-up specialist to recover revenue from aging accounts. You will analyze EOBs, ERA 835s, and CARC/RARC codes, and craft persuasive appeals with clinical documentation.

You will target denial management, including CO-45, PR-204, CO-16, CO-197, and medical necessity rejections, to keep A/R days under 35. Collaboration with payer policies is essential.

Qualifications

• 3+ years direct US healthcare A/R follow-up and denial management experience.
• Deep expertise in CARC/RARC codes, bundling guidelines, and timely filing appeal strategies.
• Demonstrated success overturning complex medical necessity and pre-authorization denials.
• Excellent written communication for drafting clinical dispute letters.

Responsabilités

• Analyze EOB and ERA 835 for CARC/RARC codes.
• Investigate denials such as CO-45, PR-204, CO-16, CO-197, and medical necessity rejections.
• Draft persuasive appeal letters with supporting clinical records and payer policy citations.
• Track and drive resolution on aging A/R to keep practice A/R days under 35.

Connaissances

AR follow-up

CARC/RARC codes

Denial analysis

Appeal drafting

Description du poste

Follow up on unpaid insurance claims, appeal clinical and administrative denials, and recover revenue in aging buckets of 60, 90 and 120+ days.

What you will do

• Analyze EOB and Electronic Remittance Advices (ERA 835) for Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC).
• Investigate denials such as CO-45, PR-204, CO-16, CO-197, and medical necessity rejections.
• Draft persuasive appeal letters with supporting clinical records and payer billing policy citations.
• Track and drive resolution on accounts in aging A/R to maintain practice A/R days under 35.

What we are looking for

• 3+ years direct US healthcare A/R follow-up and denial management experience.
• Deep expertise in CARC/RARC codes, bundling guidelines, and timely filing appeal strategies.
• Demonstrated success overturning complex medical necessity and pre-authorization denials.
• Excellent written communication for drafting clinical dispute letters.