Insurance AR Specialist - Advanced Orthopaedics & Sports Medicine

The Medical Billing and Insurance AR Specialist reports to the Billing Manager and is responsible for insurance claim clarification, accounts receivable follow-up, and payment posting. The role serves as a liaison between the billing department and providers, handling billing inquiries and claim corrections. The specialist ensures accurate coding compliance for all procedures and contributes to reducing AR through diligent follow-up on outstanding claims. Other duties include processing refunds, handling patient insurance information updates, and assisting in the development of training programs for the billing team.

Key Responsibilities:

• Basic understanding of insurance payer policies and guidelines for follow up on insurance claims and accounts receivable to ensure timely payment.
• Liaise with billing department and providers to resolve billing issues.
• Claim creation and filing via data entry, provided from 3rd party vendors
• Monthly reports for unpaid claims for ancillary services
• Ensure accurate coding and compliance with regulations on aged (120 days) unpaid claims
• Resolve discrepancies in insurance payments and posting errors.
• Process refund requests and update patient insurance information.
• Document insurance and patient correspondence and assist with billing team training.
• Basic payment posting and reconciliation from insurance and/or patients.
• Understanding of explanation of benefits for accurate assistance with patient billing questions.
• Experience and understanding of excel functions is a must

Required Skills & Competencies:

• Language Ability: Able to read and comprehend simple instructions, short correspondence or memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Spanish speaking is preferred, but not required.
• Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute ratios, rate and percent and to draw an interpret bar graphs.
• Certificates and Licenses: CPC or other coding certification preferred.
• Personal Skills: Multi-tasking, Flexibility, Telephone Skills, Customer Service, Time Management, Organization, Attention to Detail, Scheduling, Word Processing,
• Professionalism, Quality Focus. The ability to work well under pressure and an awareness and understanding of other cultures are also important.
• Vision requirement: Requires ability to perform close vision, peripheral vision, ability to adjust focus and spend up to 4-5 hrs in front of a computer.
• Education: High school diploma or GED and 1 year of related experience in medical billing or collections.
• Experience: Preferred experience in medical billing, financial accounting, or healthcare office settings.
• Skills: Basic knowledge of Microsoft Office (Word, Excel, Outlook), ability to navigate EMR systems and payer portals, and strong written and verbal communication skills. Spanish language skills are a plus.