AR Denials & Appeals Specialist

Ventra Health; United States; On-site; USD 42,000 - 66,000; Full time

Job summary

Ventra Health is seeking an Accounts Receivables Escalation Specialist to analyze collections, resolve non-payables, and handle bill inquiries for complex issues. The role focuses on payer follow-up to ensure claims are paid per client contracts, with compliance to billing standards.

The ideal candidate has at least 1 year in data entry and 1 year in medical billing/claims resolution, with knowledge of Medicare/Medicaid rules and proficiency in Excel, Outlook, and Word.

Qualifications

• High School Diploma or GED.
• 1+ year data entry and 1+ year medical billing/claims resolution preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration desired.

Responsibilities

• Follow up on claim rejections and denials to ensure appropriate reimbursement for our clients.
• Process assigned AR work lists provided by the manager in a timely manner.
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
• Identify and resolve denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
• Recommend accounts to be written off on Adjustment Request.
• Reports address and/or filing rule changes to the manager.
• Check the system for missing payments.
• Properly notates patient accounts.
• Review each piece of correspondence to determine specific problems.
• Research patient accounts.
• Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.).
• Processes and follows up on appeals. Files appeals on claim denials.
• Scan correspondence and index to the proper account.
• Inbound/outbound calls may be required for follow-up on accounts.
• Respond to insurance company claim inquiries.
• Communicates with insurance companies about the status of outstanding claims.
• Meet established production and quality standards as set by Ventra Health.
• Performs special projects and other duties as assigned.

Skills

Data entry

Medical billing

Excel

Outlook

Time management

Communication

Education

High School Diploma or GED

AAHAM certification preferred

HFMA certification preferred

Tools

Outlook

Word

Excel (pivot tables)

Database software

Job description

Ventra Health is seeking an Accounts Receivables Escalation Specialist to analyze collections, resolve non-payables, and handle bill inquiries for complex issues. The role focuses on payer follow-up to ensure claims are paid per client contracts, with compliance to billing standards.

The ideal candidate has at least 1 year in data entry and 1 year in medical billing/claims resolution, with knowledge of Medicare/Medicaid rules and proficiency in Excel, Outlook, and Word.