RCM AR Specialist

Allergy Partners; Asheville (NC); On-site; USD 48,000 - 65,000; Full time

Job summary

Allergy Partners is seeking a RCM AR Specialist to follow up on denied claims and overdue insurance balances using EOBs and reports. You will handle appeals for contract rate variances, submit medical records when requested, and monitor payer communications, maintaining detailed documentation in the system.

The role involves contacting payers, reviewing aged accounts, and building relationships with carriers.

Qualifications

• Requires at least a high school diploma or GED.
• Experience in medical billing and AR collections preferred.
• Familiarity with EOBs and insurance claim forms.
• Knowledge of CPT/ICD-10 coding.
• Strong written and verbal communication skills.
• Proficiency with practice management software and Microsoft Office.

Responsibilities

• Follow up on denied claims and overdue insurance balances.
• Submit appeals for contract rate variances.
• Submit Medical Records when requested by payer.
• Monitor payer correspondence and respond within 48 hours.
• Call payers to inquire about unpaid claims after 45 days and document activity.
• Attend regular staff meetings and training as requested.
• Maintain knowledge of software related to job functions.
• Build relationships with carrier personnel.

Skills

Medical Billing

Email proficiency

Communication skills

Practice management software

Insurance billing process

Healthcare reimbursement knowledge

CPT/ICD-10 coding

Education

High school diploma or GED

College education or trade school preferred

Tools

Practice management software

Microsoft Office

Job description

POSITION: RCM AR SpecialistRESPONSIBLE TO: RCM Supervisor, AR CollectionsJOB SUMMARY: Follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. RCM AR Specialist are assigned specific book of business based on Financial Class and Payers. Work to support the field related to claim denials.RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:Daily DutiesFollows up on denied claims and no response within a timely manner.Submits appeals related to contract rate variances with a discrepancy in allowed amounts; notifies Supervisor of payers for which this is a consistent problem.Submit Medical Records when requested by the payer for claims processing determination.Monitor and review Payer correspondence from the lockbox and faxes.Monitor, review, and respond to Hub (field) communication inquiries within the 48-hour requirement.Account Follow-UpUsing data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”.Maintains detailed knowledge of practice management and other computer software as it relates to job functions.Responds to written and telephone inquiries from insurance companies.Builds and Maintain relationships with personnel from assigned carriers.Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow up concerns.OTHERMaintains detailed knowledge of practice management and other computer software as it relates to job functions.Attends all meetings as requested including regular staff meetings.Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.Performs any additional duties as requested by RCM Leadership.Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.SUPERVISORY RESPONSIBILITIESThis position has no supervisory responsibilities.TYPICAL PHYSICAL DEMANDSPhysical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports. Working conditions are a professional office environment. If remote, must have functioning internet and are open to on-camera team calls. Occasional evening or weekend work.The salary range posted for this position is the national average, however, actual compensation may vary depending on geographic location, job-related knowledge, skills, and experience.EDUCATIONAL REQUIREMENTS:High school diploma or GED equivalent, required.College education or trade school preferred.QUALIFICATIONS AND EXPERIENCE:Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience.Comfortable using email and interacting with Internet applications.Knowledge of practice management and Microsoft processing software.Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process.Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.Basic knowledge of CPT and ICD-10 coding.Strong written and verbal communication skills.The salary range posted for this position is the national average; however, actual compensation may vary depending on geographic location, job-related knowledge, skills, and experience.