AR Specialist- Revenue Cycle Management

Gryphon-Healthcare; Houston (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

Gryphon Healthcare in Houston, TX is seeking an Account Receivable Specialist to manage claims submissions, appeals of denied claims, and interactions with commercial carriers to accelerate payments. This onsite role requires accuracy, HIPAA compliance, and strong communication with patients and insurers.

You will monitor denied claims, follow up with insurance carriers, and document all interactions in the billing system.

Qualifications

• Two years of medical billing experience preferred.
• Knowledge of medical billing practices and payer requirements.
• Ability to explain out-of-pocket expenses and EOBs to patients and carriers.

Responsibilities

• Daily monitoring of denied claims and re-processing with correct demographic and coding information to ensure timely filing through the clearinghouse.
• Follow-up on all denied claims to secure payment from insurers.
• Use AR worklist to identify unpaid claims and follow up with carriers to re-process or appeal.
• Initiate tracers with commercial insurance carriers to locate missing payments.
• Document all communications from insurers in the billing system for tracking purposes.
• Identify billing trends and communicate with the AR Manager to improve accuracy.
• Provide support to billing and auxiliary departments as needed.
• Stay updated on HIPAA rules and changes in medical billing regulations.
• Maintain a 30-50 claim resolution rate per day.
• Performs other duties as assigned.

Skills

Medical billing

Denials management

HIPAA knowledge

Customer service

English communication

Excel basics

Education

High School Diploma or equivalent

Tools

Collaborate

GoRev

Clearinghouses

EMR/EHR systems

EDI systems

Microsoft Excel

Job description

Job Title: Account Receivable Specialist

Location: Houston, TX (Onsite - Corporate Office)

Schedule: Full-Time, 40 hours per week

About Gryphon Healthcare

Gryphon Healthcare is a Houston-based revenue cycle management company serving healthcare providers nationwide. We pride ourselves on delivering results through accountability, transparency, and a hands-on approach, what we call \"The Gryphon Difference.\" Our team is collaborative, driven, and committed to supporting one another while delivering exceptional outcomes for our clients.

JOB SUMMARY

The Account Receivable Specialist is responsible for submitting claims, appeals of denied claims and working with commercial insurance carriers to ensure prompt accurate payment.

DUTIES AND RESPONSIBILITIES

• Daily monitoring of denied claims in assigned billing system and re-processing the claims with correct demographic and coding information to ensure timely filing through the clearinghouse.
• Follow-up on all denied claims to ensure payment from Insurance companies.
• Utilize weekly Accounts Receivable work list to identify unpaid claims and follow-up with insurance carriers to re-process or appeal claims.
• Initiate tracers with commercial insurance carriers to locate missing or lost payments.
• Document all communication from insurance companies and patients pertaining to the claim status in billing system for tracking purposes.
• Identify and communicate billing trends, including recurrent denials to the AR Manager, which increase accuracy in the billing process.
• Provide support as needed, to all members of the billing and auxiliary departments at Gryphon Healthcare.
• Stay abreast of current issues, trends and changes in the laws and regulations governing medical billing.
• Demonstrates professional customer service standards when communicating with patients and insurance representatives on the phone or in email correspondence.
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
• Maintains a minimal claim resolution rate of 30 - 50 claims per day.
• Performs other duties as assigned.

EDUCATION REQUIREMENTS

High School Diploma or equivalent required

EXPERIENCE REQUIREMENTS

2 years in medical billing preferred with the following detailed experience:

• Knowledge of medical / billing collection practices
• Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors.
• Knowledge of basic medical coding and third-party operating procedures and practices
• EMR, EDI and Commercial Insurance Company systems
• PM Systems such as Collaborate and GoRev, including multiple clearinghouses and payments systems.
• Out of Network (OON) negotiations, appeals and reconsiderations.
• Ability to interpret and clearly explain out-of-pocket expenses, EOBs, and CARC/RARC codes to patients, carriers, and other callers.
• Basic computer literacy includes keyboarding skills, Microsoft system (Outlook, Teams, Excel & Words) and the ability to navigate in a Windows environment.
• Understands basic concepts of Excel spreadsheets for work queue.
• Detail oriented, strong organizational skills and the ability to prioritize workload
• Must demonstrate interpersonal skills with all levels of the billing and management team
• Excellent oral and technical writing and typing skills.
• Must be able to write and speak effectively in English

WORKING ENVIRONMENT

• Onsite role in Gryphon's Houston corporate office
• Ability to sit, stand, and use office equipment for extended periods
• Occasional lifting up to 20 lbs. (files, materials)
• Ability to work in a fast-paced, high volume and dynamic environment.
• Able to flex hours as needed to meet needs related to unanticipated volume, changes and/or problems.