Revenue Cycle AR Specialist

About What You’ll Work On:

• Manage assigned A/R through consistent follow-up using payer portals, phone, and CentralReach Claim Accelerator to drive timely claim resolution and payment.

• Research and resolve claim status, denials, rejections, underpayments, overpayments, recoupments, and payment discrepancies, including review of EOBs/ERAs and payer adjudication.

• Submit corrected claims, reconsiderations, appeals, and supporting documentation as needed, including medical records, while maintaining HIPAA and confidentiality requirements.

• Identify and communicate billing errors, recurring payer issues, and claim trends to the RCM Manager and billing team.

• Assist with payer audits, insurance refunds, adjustments, and recoupments, ensuring required documentation and approvals are completed timely.

• Research and resolve timesheet and claim-related issues, including approved IT corrections and transaction adjustments.

• Maintain accurate and detailed A/R notes and claim documentation in CentralReach, including payer contacts, follow-up actions, status, and resolution.

• Monitor timely filing deadlines and payer-specific requirements, including changes to billing, authorization, coding, and reimbursement guidelines.

• Support A/R cleanup, payer research, denial reduction, process improvement, and other RCM projects as assigned by the RCM Manager.

• Provide professional and timely assistance to providers and internal departments regarding billing and insurance questions and escalate issues appropriately.

• Perform other RCM-related duties as assigned.

Qualifications:

• 3+ years of healthcare medical billing and/or A/R experience required.

• Strong understanding of the healthcare revenue cycle, including claim submission, payer adjudication, denials, appeals, payment posting, and A/R follow-up.

• Experience researching claims and identifying the root cause of billing and payment issues.

• Experience with medical billing and medical coding.

• Knowledge of ABA billing and behavioral health revenue cycle processes preferred.

• Knowledge of Speech-Language Pathology and Occupational Therapy billing practices preferred.

• Familiarity with ABA CPT codes and payer-specific billing requirements preferred.

• Experience working with Commercial, Medi-Cal/Medicaid, and managed care payers preferred.

• Familiarity with payers across California, Arizona, Colorado, Texas, Virginia, and Washington is a plus.

• Experience working with CentralReach (CR) strongly preferred.

• Experience with electronic payer portals and clearinghouses preferred.

• Associate degree and/or medical billing/coding certification such as AHIMA or AAPC preferred.

• Strong analytical and problem-solving skills with the ability to research complex claim issues and determine appropriate next steps.

• Excellent attention to detail and a high degree of accuracy.

• Strong written and verbal communication skills.

• Ability to communicate professionally with insurance representatives, providers, families, and internal departments.

• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

• Strong sense of urgency and ownership of assigned A/R.

• Highly organized, dependable, and self-motivated.

• Ability to work independently while also functioning effectively as part of a team.

• Comfortable learning new systems, processes, and payer requirements quickly.

• Strong customer service skills and a professional, solutions-oriented approach.