AR Specialist

🕒 August 28

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💰 Accounts Receivable

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 35%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Healthrise

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚖️ Legal

📦 Logistics

Healthcare • Legal • Logistics

Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized.

📋 Description

• Perform day-to-day payment resolution activities within Hospital and/or Medical Group partner revenue operations • Receive, analyze, and appeal post-billed denials, including clinical denials • Research and resolve payment delays and variances from rejected or denied claims, overpayments, and underpayments • Process payments according to contracts and policies to ensure timely and accurate liability resolution • Resolve claims, conduct formal account reviews, identify lost charge recovery, and document delays and payment variances • Identify routine issues and resolve or escalate them appropriately • Maintain knowledge of state and federal laws relating to contracts and appeals • Investigate overpayment and underpayment accounts to optimize reimbursement • Coordinate with clinical departments to support appeals • Collaborate with Patient Access and stakeholders to resolve authorization issues • Apply payer rules, contracts, schedules, and other data to resolve payment variances • Follow up with patients and commercial, Medicare, and Medi-Cal payers; refile accurate claims and document findings • Contact insurance carriers and patients to resolve outstanding balances • Monitor California payer timely filing limits and submit claims within deadlines • Research payer trends and provide feedback to improve billing accuracy and efficiency • Track and report denial types and root causes, recommending process improvements • Analyze, categorize, and resolve denials from commercial, government, and managed care payers • Identify denial root causes and work with clinical and coding teams on resolution • File appeals and reconsiderations according to California-specific timelines • Request write-offs, transfers, allowances, and reversals as needed • Recommend accounts for transfer to collection vendors • Document actions in the patient accounting system • Respond to or refer patient and payer inquiries • Communicate with physicians, office staff, and hospital departments to gather and verify information • Prepare reports on trends, outcomes, and claim activity • Cross-train in various functions and continuously learn the Denials Resolution Specialist role • Interpret data, draw conclusions, and review findings with supervisor • Perform other duties as assigned

🎯 Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or related field, with a minimum of two (2-3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management functions in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial service setting; or an equivalent combination of education and experience • Experience in a complex, multi-site environment within California healthcare systems preferred • Excellent written and verbal communication and organizational skills • Strong interpersonal and customer service skills • Attention to detail, accuracy, and time management • Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel) • Completion of regulatory/mandatory certifications preferred • Comfortable working in a collaborative, shared leadership environment • Previous experience with Global Partner vendors preferred • Experience using Epic • Familiarity with CPT, ICD-10, and HCPCS coding • Strong organizational, communication, and problem-solving skills • Ability to work independently, meet deadlines, and maintain high attention to detail • Preferred Certification: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent • Maintains a working knowledge of applicable Federal, State, and local laws/regulations

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