Revenue Cycle Specialist II - AR & Denials Follow-Up

*THIS IS A REMOTE POSITION*

RESPONSIBILITY:

Primarily responsible for effective billing and collections for all ENT Specialty Partners offices. Is able to resolve claim issues by utilizing knowledge of company policies and procedures, medical coding, insurance reimbursement practices, and collection laws. Must have experience with hearing aid claims processing and follow-up, including understanding payer benefits, coverage limitations, claim submission, denial resolution, and patient responsibility.

Primary Responsibilities:

• Perform timely and thorough insurance AR follow-up on outstanding claims and balances.
• Monitor claim status and contact insurance carriers to resolve unpaid, underpaid, and denied claims.
• Research and work denials, reconsiderations, appeals, and payer requests for additional information or medical records.
• Identify the root cause of claim denials and determine the appropriate resolution, including corrected claims, reconsiderations, appeals, or additional documentation.
• Review claim history, payments, adjustments, charges, and account activity within the EHR to ensure accurate account resolution.
• Review and interpret insurance correspondence, Explanation of Benefits (EOBs), remittance information, and payer responses.
• Coordinate with providers and internal departments when additional information, documentation, coding clarification, or other action is required to resolve a claim.
• Maintain accurate and detailed documentation of all AR follow-up activity and payer communications.
• Follow HIPAA requirements when handling patient information and providing or requesting medical records.
• Accurately enter and maintain account and claim information within the computer system.
• Work assigned AR inventory according to established priorities, productivity expectations, and follow-up timeframes.
• Respond to account-related correspondence and payer inquiries in a timely manner.
• Provide professional and respectful customer service to patients and their families when assistance is needed regarding insurance balances.
• Work effectively both independently and as part of a team to meet departmental goals.
• Maintain confidentiality of patient and company information.
• Perform other related duties as assigned.

The ability to independently work insurance AR, denials, reconsiderations, and appeals is a key expectation of this position. Candidates should have a demonstrated foundation of at least 3–5 years of experience in these areas.

Required Experience:

• Minimum of 3–5 years of hands-on experience in medical insurance AR follow-up.
• Demonstrated experience with insurance claim follow-up, denials, reconsiderations, and appeals.
• Strong understanding of insurance payer requirements, claim processing, timely filing, authorizations, eligibility, coding-related denials, medical records requests, and other common reimbursement issues.
• Experience researching unpaid and denied claims, determining the appropriate next action, and documenting follow-up activity accurately.
• Ability to work independently and manage a high-volume AR workload while meeting established productivity and quality expectations.