AR Follow-Up Specialist III – Coding and Complex Denials

Jobtailor; United States; On-site; USD 38,000 - 65,000; Full time

Job summary

Jobtailor seeks a Medical Billing/Denials Specialist to work with ColumbiaDoctors’ network, focusing on gathering documentation, submitting appeals, and overturning coding-related denials. You will coordinate with CPCs and supervisors to resolve complex cases and improve denial-management processes.

Ideal candidates have 2+ years in physician billing, strong customer service, and proficiency with Epic and MS Office.

Qualifications

• High school diploma or GED required.
• 2+ years in physician billing or third-party payer environment.
• Ability to understand contracts, insurance benefits, exclusions, and billing rules.
• Knowledge of claim forms, HMOs, PPOs, Medicare, Medicaid and compliance regulations.
• Strong customer service and patient-focused orientation.
• Ability to explain insurance benefits, exclusions, denials, and payer adjudication.

Responsibilities

• Collaborate with CPCs to gather documentation and overturn coding-related denials.
• Elevate complex cases to CPCs or supervisors.
• Prepare and submit denials appeals with Letters of Medical Necessity.
• Address correspondence related to denials and respond promptly.
• Identify denial patterns and escalate trends to supervisors.
• Assist in monitoring work queues and other duties.
• Support training of new hires on coding and denial workflows.
• Contact payers, patients, or guarantors regarding outstanding claims and appeals.
• Update demographics and insurance coverage accurately.

Skills

Customer service

Verbal communication

Written communication

Insurance benefits explanations

Documentation accuracy

Process improvement

Medical terminology

Denial adjudication

Education

High school diploma or GED

Tools

Epic

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

• Work closely with Certified Professional Coders (CPCs) to gather documentation, support appeals, and overturn coding-related denials
• Elevate cases requiring advanced coding review to CPCs or supervisors
• Prepare and submit appeals for denied claims, including Letters of Medical Necessity and supporting documentation
• Address correspondence related to coding denials and respond promptly
• Identify coding-related denial patterns and elevate trends to supervisors
• Provide input on process improvements and denial-management best practices
• Assist the Assistant Director/Supervisor with monitoring work queues and other assigned duties
• Support training of new hires on coding and complex-denial workflows
• Contact insurance companies, patients, or account guarantors by phone, correspondence, and online portals regarding outstanding claims and appeals
• Perform demographic and insurance coverage updates, documenting corrections and billing accurately
• Address third-party sponsorship issues and follow up as needed
• Collaborate with ColumbiaDoctors, a large multi-specialty healthcare provider network

Requirements

• High school graduate or GED certificate is required
• A minimum of 2 years’ experience in a physician billing or third party payer environment
• Ability to understand and navigate contracts, insurance benefits, exclusions, and other billing requirements
• Understanding of claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations
• Strong customer service and patient-focused orientation
• Ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process
• Effective verbal and written communication skills
• Intermediate proficiency in Microsoft Word, Excel, Outlook, email, and other computer software
• Experience in Epic and/or other electronic billing systems is preferred
• Knowledge of medical terminology, diagnosis, and procedure coding is preferred
• Previous experience in an academic healthcare setting is preferred

Core Competencies

Demonstrates expertise in medical billing processes, including appeals management and coding-related denials, while effectively communicating with patients and insurance providers. Proficient in utilizing electronic billing systems and understanding insurance contracts and compliance regulations.

Highest-signal resume keywords

• Medical Billing Experience
• Claims Appeals Management
• Understanding of Insurance Benefits
• Effective Communication Skills
• Proficiency in Electronic Billing Systems

Hard Skills

• Medical Terminology
• Diagnosis Coding
• Procedure Coding
• Claim Forms Understanding
• Billing Requirements Navigation
• Denial Management
• Process Improvement
• Insurance Coverage Updates
• Documentation Accuracy
• Customer Service Orientation

Soft Skills

• Patient-Focused Orientation
• Effective Verbal Communication
• Effective Written Communication

Industry Keywords

• CPC
• HMO
• PPO
• Medicare
• Medicaid
• Compliance Program Regulations
• Third Party Payer Environment
• Academic Healthcare Setting

Tools & Technologies

• Epic
• Microsoft Word
• Microsoft Excel
• Microsoft Outlook
• Email Software