AR Analyst Revenue Integrity & AR Optimization

AR Analyst Revenue Integrity & AR Optimization Job Description: Our healthcare revenue cycle management (RCM) division's "Revenue Recovery Specialist" and "Claims Management Anchor" are the AR Analyst in Medical Billing. Organizing the complete collection of unpaid accounts receivable from commercial insurance companies, government payers (Medicare/Medicaid), and patients is your main responsibility. As the "Payer Liaison and Denial Investigator," you take direct, hands-on responsibility for elderly insurance claims, determining the underlying reasons for nonpayment, evaluating intricate Explanations of Benefits (EOB), and carrying out appeal tactics to optimize collections. At the core of corporate financial risk mitigation is this role, which consciously recognizes and eliminates important cash flow risks such as unappealed insurance rejections, systemic payer denial trends, timely filing expirations, inaccurate clearinghouse data, and growing Days Sales Outstanding (DSO). Key Duties: Aged Accounts Receivable Recovery & Analysis: Target outstanding claims that are more than 30, 60, or 90 days old for prompt financial resolution by methodically analyzing aging AR reports utilizing Excel and billing platforms. Claim Denial Management & Root Cause Tracking: Examine denials and rejections of claims, swiftly amending and resubmitting them. Payer Appeals & Grievance Execution: To overturn unlawful payer decisions, draft and submit organized, legally compliance medical appeal letters backed by clinical notes, medical records, and state insurance rules. Direct Insurance Provider Engagement: To communicate with insurance claim adjusters, audit processing problems, and expedite payment timeframes, make expert outbound calls and use web portals. EOB, ERA, and Adjustment Auditing: Examine both manual and electronic remittance advice (ERA). Explanation of Benefits documentation, confirming that contractual write-offs and allowances correspond with insurance contracts. Patient Billing Support & Account Adjustments: Respond to complicated patient billing questions about out-of-pocket balances, copayments, and deductibles, creating structured payment plans as needed. Clearinghouse & Charge Scrubber Exception Clearance: Keep an eye on the daily electronic clearinghouse logs to identify and address front-end claim modifications before they become official insurance rejections. Metrics for Revenue Performance Reporting: Create and update important monthly summaries of collections tracking, maintaining historical cash collection ledgers, modifications, and write-off metrics in tracking spreadsheets for management evaluations. We invite you to apply and explore this exciting opportunity! Warm Regards, HR - Maria