What are the responsibilities and job description for the AR Denial Specialist position at The Recovery Center USA?
Position: Accounts Receivable Denial Specialist
Reports to: Chief Financial Officer
Job Summary:
The Accounts Receivable Denial Specialist is responsible for resolving claim payment issues by working directly with commercial, governmental, and other payers to secure timely and accurate reimbursement. This role involves analyzing denied claims, resolving payment variances, and submitting technical and clinical appeals to address discrepancies effectively. The specialist will also play a key role in identifying trends and contributing to process improvements to reduce denials and optimize accounts receivable performance.
Primary Responsibilities:
- Analyze denied and unpaid claims to determine the root cause of discrepancies and take corrective action.
- Communicate directly with payers to resolve outstanding claims, payment variances, and appeals, ensuring timely reimbursement.
- Draft and submit technical and clinical appeals for denied claims as necessary.
- Identify specific reasons for underpayments, denials, and delays in payment, and collaborate with management to address systemic issues.
- Stay current on federal and state regulations and payer-specific requirements, ensuring all actions comply with industry standards.
- Maintain detailed documentation of all activities, including payer communications, claim statuses, and resolution efforts.
- Monitor trends in denials and variances, providing actionable insights and recommendations to management.
- Rebill claims not paid within 24 hours of denial.
- Post payments accurately and generate daily reports on posted payments, denials, and related activities.
Required Knowledge, Skills, and Abilities:
- Proficiency in Microsoft Excel and basic computer skills.
- Strong verbal communication skills.
- Critical thinking and problem-solving skills to create actionable plans for claim resolutions.
- Ability to adapt to changing procedures in a dynamic, growing environment.
- Meet quality and productivity standards within established timelines.
- Ability to maintain high attendance and reliability.
Preferred Knowledge, Skills, and Abilities:
- 2- or 4-year college degree.
- 1 years of relevant experience in medical collections, physician/hospital operations, AR follow-up, denials & appeals, compliance, provider relations, or professional billing.
- Familiarity with claims review, analysis, and medical/revenue cycle terminology.
- Experience working with Medicaid systems and payer websites to investigate claim statuses.
- Working knowledge of revenue cycle processes and medical terminology.
Key Attributes for Success:
- Strong analytical and organizational skills.
- Initiative and resourcefulness in resolving claims and identifying root causes.
- Ability to meet deadlines while maintaining high-quality performance.
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