AR Specialist (51204)

Medical Accounts Receivable (A/R) Revenue Specialist

Position Summary

The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.

Key Responsibilities

Claims & Vendor Management

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Partner with external billing vendors to address claim rejections and payer requests for clarification.

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Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions.

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Review escalated accounts requiring internal oversight or final resolution.

Denial Management & Appeals

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Collaborate with vendor partners to identify denial trends, recurring payer issues, and root causes.

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Provide feedback and strategic direction on appeal approaches and payment resolution tactics.

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Authorize final adjustments after all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance.

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Recommend process improvements to reduce future denials.

Accounts Receivable Follow-Up

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Proactively work A/R aging reports (30, 60, 90+ days) to identify unpaid or underpaid claims.

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Initiate payer tracers and follow-ups to secure claim adjudication and payment.

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Monitor high-risk and high-dollar accounts to prevent revenue leakage.

Payment Posting & Reconciliations

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Ensure accurate posting and reconciliation of insurance and patient payments.

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Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy.

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Assist with account reconciliations and discrepancies resolution as needed.

Patient & Insurance Communication

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Act as a liaison between patients and insurance payers to resolve billing questions.

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Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.

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Conduct professional and empathetic phone communication with patients and payer representatives.

Qualifications & Requirements

Education

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High School Diploma or equivalent required

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Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred

Experience

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1–3 years of experience in:

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Medical billing and collections

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Accounts Receivable or Revenue Cycle Management

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Healthcare payer follow-up and denial resolution

Technical Skills

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Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)

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Strong working knowledge of Microsoft Office, particularly:

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Excel (reports, aging analysis)

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SharePoint

Medical & Regulatory Knowledge

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Working knowledge of:

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Medical terminology

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CPT and ICD-10 coding

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Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans

Core Competencies

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Strong analytical and problem-solving skills

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Exceptional attention to detail and accuracy

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Effective written and verbal communication skills

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Ability to work collaboratively with internal teams and external vendor partners

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Sound judgment related to financial adjustments and account resolution