RCM AR Specialist

Allergy Partners; Asheville (NC); On-site; USD 40,000 - 60,000; Full time

Job summary

Allergy Partners in Asheville, NC is seeking an RCM AR Specialist responsible for managing claim denials and overdue insurance balances. This role requires experience in medical billing and collections, with a focus on supporting field operations related to claim issues.

The ideal candidate will possess strong communication skills, can utilize practice management software, and demonstrates proficiency in the insurance billing process.

Join our team in a professional office environment with opportunities for ongoing education.

Qualifications

• High school diploma or GED equivalent required.
• Previous Medical Billing and Collections experience preferred.
• Proven understanding of Explanation of Benefits forms and insurance billing.

Responsibilities

• Follows up on denied claims and no response within a timely manner.
• Submits appeals related to contract rate variances.
• Maintains detailed knowledge of practice management as it relates to job functions.

Skills

Medical Billing and Collections experience

Strong written communication skills

Strong verbal communication skills

Knowledge of Microsoft processing software

Education

High school diploma or GED equivalent

College education or trade school preferred

Tools

Practice management software

Email applications

Job description

Job Details

Job Location: 95-00-Corporate - Asheville, NC 28803
Job Title: RCM AR Specialist
Responsible to: RCM Supervisor, AR Collections

Job Summary

Follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. RCM AR Specialists are assigned a specific book of business based on Financial Class and Payers. Work to support the field related to claim denials.

Responsibilities

Daily Duties

• Follows 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-Up

• Using 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 maintains relationships with personnel from assigned carriers.
• Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow up concerns.

Other

• Maintains 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 Responsibilities

This position has no supervisory responsibilities.

Typical Physical Demands

Physical 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.

Qualifications

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.