AR Specialist

Job not on LinkedIn

November 7

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

⏰ Full Time

🟢 Junior

🟡 Mid-level

💰 Accounts Receivable

🦅 H1B Visa Sponsor

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Healthrise

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Healthcare Insurance • Consulting • SaaS

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.

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

📋 Description

• Performs day-to-day payment resolution activities within the Hospital and/or Medical Group partner revenue operations. • Scope of responsibility includes all post-billed denials (inclusive of clinical denials). • Ensures payments are received on denied accounts, determining root causes for discrepancies. • Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims. • Processes payments as appropriate in accordance with contracts and policies. • Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes and documents delays and payment variances. • Identifies routine issues and resolves them as appropriate. • Maintains knowledge of state and federal laws as they relate to contracts and the appeals process. • Investigates and addresses overpayment and underpayment accounts. • Coordinates follow-up with clinical departments to provide support for appeals. • Collaborates with Patient Access and other stakeholders to resolve account authorization issues. • Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances. • Proactively follows up on delays and variances with patients, commercial, Medicare, and Medi-Cal payers. • Contacts insurance carriers and patients as necessary to resolve outstanding balances. • Monitors timely filing limits specific to California payers. • Researches payer trends and provides feedback to improve billing accuracy and efficiency. • Tracks and reports denial types and root causes, recommending process improvements. • Analyzes, categorizes, and resolves claim denials from various payers. • Identifies root causes of denials and works with clinical and coding teams for resolution. • Files appeals and reconsiderations according to California-specific appeal timelines. • Requests write-offs, transfers, allowances, and reversals as needed. • Recommends accounts for transfer to collection vendors based on complexity and status. • Documents all actions in the patient accounting system. • Responds to patient and payer inquiries or refers them as needed. • Communicates with physicians, office staff, and hospital departments to gather and verify necessary information. • Prepares and submits reports documenting trends, outcomes, and claim activity.

🎯 Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or related field • Minimum of two (2-3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management functions • 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) • Strong understanding of California-specific payers (Medi-Cal, Blue Shield of CA, Kaiser, CalOptima, IEHP, Partnership HealthPlan, Division of Financial Responsibility, etc.) • Familiarity with CPT, ICD-10, and HCPCS coding • Preferred Certification: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent • Experience with California Medicaid (Medi-Cal), Share of Cost, and managed care environments • Bilingual (English/Spanish) preferred.

🏖️ Benefits

• Completion of regulatory/mandatory certifications preferred • Comfortable working in a collaborative, shared leadership environment • Previous experience with Global Partner vendors preferred • Health insurance • Professional development opportunities • Paid time off • Flexible work arrangements