AR Follow-Up Specialist III - Coding and Complex Denials #Full Time #Remote

servcorphr; New Jersey; Hybrid; USD 40,000 - 50,000; Full time

Benefits offered by this job

Healthcare benefits

Paid time off

Job summary

61st Street Service Corporation seeks an AR Follow-Up Specialist III, Coding and Complex Denials, to resolve complex denials and follow up on unpaid claims in collaboration with CPCs. The role involves preparing appeals, updating records, and identifying denial trends for process improvements.

Expect remote work with occasional in-person trainings in the Tri-State area. Requirements include a high school diploma and at least 2 years in physician billing or third-party payer environments.

Qualifications

• High school diploma or GED required.
• Minimum 2 years’ experience in a physician billing or third party payer environment.
• Ability to understand contracts, insurance benefits, exclusions, and payer rules.
• Strong customer service and patient-focused orientation with clear communication.
• Proficient in Microsoft Word, Excel and Outlook; Epic or EHR experience preferred.
• Knowledge of medical terminology, diagnosis and coding preferred.
• Experience in an academic healthcare setting is a plus.

Responsibilities

• Collaborate with CPCs to gather documentation and support appeals.
• Elevate complex cases to CPCs or supervisors as needed.
• Prepare and submit appeals with supporting documentation.
• Address incoming correspondence regarding coding denials and respond promptly.
• Identify denial patterns and report trends to improve processes.
• Contribute to denial management best practices and efficiency.
• Assist with monitoring work queues and related duties.
• Support training of new hires on coding and denial workflows.
• Contact insurers, patients, or guarantors to obtain claim status and appeals.
• Update demographics and insurance coverage on accounts with proper documentation.

Skills

Verbal communication

Written communication

Customer service

Attention to detail

Education

High school diploma or GED

Tools

Epic EHR

MS Word

MS Excel

Outlook

Job description

Top Healthcare Provider Network

The 61st Street Service Corporation, provides administrative and clinical support staff for ColumbiaDoctors. This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors’s practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.

This position is primarily remote, candidates must reside in the Tri-State area (New York, New Jersey, Connecticut). Note: There may be occasional requirements to visit the office for training, meetings, and other business needs. Opportunity to grow as part of the Revenue Cycle Career Ladder!

Job Summary:

The AR Follow-Up Specialist III, Coding and Complex Denials is responsible for addressing and resolving complex coding-related denials and appeals in addition to following up on unpaid accounts with insurance companies and third parties. This role requires close collaboration with Certified Professional Coders (CPS) and other coding professionals to successfully appeal denied claims and ensure compliance with payer guidelines. The Specialist III assists the unit supervisor and manager with complex cases, supports training efforts, and identifies denial trends to inform process improvements. Professionalism and courteous communication are essential in all interactions.

Job Responsibilities:

• Work closely with Certified Professional Coders (CPCs) to gather documentation, support appeals, and overturn coding-related denials effectively.
• Elevate cases requiring advanced coding review to appropriate CPCs or supervisors as needed.
• Prepare and submit appeals for denied claims, including Letters of Medical Necessity and other supporting documentation, in collaboration with coding professionals.
• Address incoming correspondence related to coding denials and respond timely to ensure prompt resolution.
• Identify patterns in coding-related denials and elevate trends to supervisors to improve processes and reduce future denials.
• Provide input on process improvements and best practices to enhance the efficiency of denial management.
• Assist Assistant Director/Supervisor with monitoring work queues and other assigned duties related to coding and denial follow-up.
• Support the training of new hires, particularly on coding and complex denial workflows.
• Contact insurance companies, patients, or account guarantors via phone, correspondence, and online portals to obtain the status of outstanding claims and submitted appeals.
• Perform demographic and insurance coverage updates on accounts as appropriate, ensuring all corrections are properly documented and billed.
• Address issues related to third-party sponsorship and follow up as needed.

Job Qualifications:

• High school graduate or GED certificate is required.
• A minimum of 2 years’ experience in a physician billing or third party payer environment.
• Candidate must demonstrate the ability to understand and navigate contracts, insurance benefits, exclusions, and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
• Candidate must demonstrate strong customer service and patient-focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process.
• Must demonstrate effective communication skills both verbally and written.
• Intermediate proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• 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.

Hourly Rate Ranges: $28.72 - $36.92

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

61st Street Service Corporation

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.