Revenue Cycle Specialist II - AR & Denials Follow-Up

*Please note that we are only considering applicants who currently reside in Texas, Maryland, Virginia, or Pennsylvania*

Insurance AR Follow-Up Specialist

This position is responsible for managing and performing insurance accounts receivable (AR) follow-up , including claim status review, denials, reconsiderations, appeals, and resolution of outstanding insurance balances. The ideal candidate will have a strong understanding of the insurance billing and reimbursement process and be able to independently identify and resolve claim issues. ENT experience preferred, not required.

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.

Qualifications

MINIMAL REQUIREMENTS:

- Minimum of 3–5 years of hands-on experience in medical insurance AR follow-up. ENT a plus.

- 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.