AR Specialist

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SMOC is proud to have a team of professionals who share our passion for and commitment to excellence and our sense of compassion.

Denials & Accounts Receivable Specialist

Position Summary

The Denials & Accounts Receivable Specialist is responsible for researching and resolving insurance claim denials, managing outstanding accounts receivable, processing insurance payments, and submitting appeals when necessary. This position works with insurance companies, patients, and internal departments to resolve billing discrepancies and support accurate reimbursement.

Essential Duties and Responsibilities

Denials & Appeals

• Review and research insurance claim denials to determine the cause of nonpayment.
• Identify billing or claim errors and correct or resubmit claims when appropriate.
• Prepare and submit insurance appeals with supporting documentation as required.
• Maintain accurate documentation of denial activity and resolution efforts.

Accounts Receivable & Insurance

• Review assigned accounts receivable and address outstanding insurance balances.
• Research unpaid claims, underpayments, and payment discrepancies to determine appropriate resolution.
• Communicate with insurance carriers to resolve billing issues and obtain necessary claim information.
• Maintain accurate account notes and collection documentation.

Insurance Payment Processing

• Post insurance payments accurately to patient accounts.
• Review payment information to identify discrepancies and ensure proper account application.
• Research and resolve payment posting issues and other insurance-related account discrepancies.

Patient & Departmental Support

• Assist patients with billing questions, copay inquiries, and account-related concerns as needed.
• Provide backup insurance verification support as needed.
• Send requested medical records to insurance companies and other authorized parties to support claims, appeals, and payment resolution.
• Work with internal departments to obtain information necessary to resolve billing issues.
• Assist with additional billing and revenue cycle duties as assigned.

Required Qualifications

• High school diploma or equivalent.
• 1 year experience in medical billing, insurance denials, or accounts receivable preferred.
• Working knowledge of medical billing, insurance reimbursement, claim denials, and appeals.
• Ability to research billing issues and maintain accurate account documentation.

Essential Competencies

• Strong attention to detail and organizational skills.
• Effective written and verbal communication skills.
• Analytical and problem-solving abilities.
• Ability to prioritize tasks and manage multiple responsibilities.
• Proficiency in computer applications and patient billing systems.
• Professionalism and the ability to work effectively with patients, insurance representatives, and internal staff.

The above job description provides a general overview of the responsibilities and qualifications associated with this position. Additional duties may be assigned based on departmental needs.