Overview

The Insurance Denials & AR Specialist supports the Billing department by reviewing, researching, and resolving insurance claim denials to ensure accurate and timely reimbursement. This role analyzes explanation of benefits (EOBs), corrects and resubmits claims, and prepares appeals with appropriate documentation. The Specialist monitors denial trends, works AR reports, and collaborates with the billing and coding teams to address documentation or coding issues contributing to denials. By combining detailed account follow-up with proactive process improvement, this position plays a key role in reducing denials and strengthening the overall revenue cycle.

Key Responsibilities

·       Review and work all pending insurance denials to identify the cause and take corrective action to secure payment.

·       Analyze insurance explanation of benefits (EOBs) to identify denial reasons and determine appropriate follow-up action.

·       Correct and resubmit denied claims or prepare appeals with appropriate documentation to ensure timely reimbursement.

·       Work open accounts receivable (AR) reports and denial spreadsheets, following up on outstanding claims to reduce aging balances.

·       Review and correct Availity errors to ensure claims are submitted cleanly to insurance carriers.

·       Identify denial trends and provide feedback to leadership for process improvement.

·       Advise billing and coding staff on documentation or coding issues that contribute to denials, assisting in prevention efforts.

·       Answer and assist patients with billing questions via phone, providing accurate information regarding claim status, balances, and insurance coverage.

·       Collaborate with other billing team members to resolve claim issues and prevent repeat denials.

·       Assist the front office team with billing-related questions through chat when necessary.

·       Maintain detailed documentation of denial resolution efforts in the patient account.

·       Other duties as assigned. This job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee. They may change, or new ones may be assigned at any time with or without notice.

Qualifications

·       High school diploma or equivalent required; associate degree in healthcare administration, business, or related field preferred.

·       Minimum of 2 years of experience in medical billing, insurance denials management, or accounts receivable follow-up in a healthcare setting.

·       Strong knowledge of insurance claim processes, denial codes, and payer requirements.

·       Ability to analyze explanation of benefits (EOBs), identify denial trends, and recommend process improvements.

·       Proficiency with practice management systems (NextGen experience preferred) and payer portals (including Availity).

·       Excellent problem-solving and analytical skills with strong attention to detail.

·       Effective communication skills to advise billing and coding staff on denial prevention strategies.

·       Ability to manage multiple priorities, meet deadlines, and work independently in a fast-paced environment.

·       Proficiency in Microsoft Office Suite (Word, Excel, Outlook), including spreadsheet management for denial tracking.

·       Knowledge of HIPAA regulations and ability to maintain confidentiality.

Physical Demands

·       Prolonged periods of sitting at a desk and working on a computer.

·       Ability to use hands and fingers to handle, control, or feel objects and operate a keyboard.

·       Occasional standing, walking, bending, and reaching as needed to access files or office equipment.

·       Visual acuity to read and enter data accurately into electronic systems.

·       Hearing and speech ability sufficient to clearly communicate with patients, coworkers, and insurance representatives in person, over the phone, and through electronic communication systems.

·       Ability to handle multiple tasks in a fast-paced environment with frequent interruptions.

·       Must be able to communicate clearly and professionally in person, over the phone, and electronically.