Claims Denials & AR Management Specialist

Claims Denials & AR Management Specialist

Position Overview

The Claims Denials & AR Management Specialist is responsible for investigating claim denials, resolving outstanding accounts receivable issues, and improving reimbursement outcomes. This role focuses on identifying root causes of claim rejections, managing payer follow-up, submitting appeals and corrected claims, and partnering with internal teams to optimize revenue cycle performance while maintaining compliance with payer guidelines and regulatory requirements.

Key Responsibilities

Claims Denial Resolution & Follow-Up

• Review and analyze denied, rejected, and underpaid healthcare claims to determine appropriate resolution strategies
• Research claim issues related to billing errors, coding discrepancies, missing documentation, and payer requirements
• Submit corrected claims, reconsiderations, and appeals within required payer timelines
• Perform timely follow-up with insurance carriers to resolve outstanding balances and maximize reimbursement

Accounts Receivable Management

• Manage assigned accounts receivable inventory and prioritize claims based on aging, payer requirements, and financial impact
• Monitor outstanding claims and take appropriate action to reduce aged AR balances
• Communicate with payers to verify claim status, resolve payment discrepancies, and secure claim adjudication updates
• Maintain accurate documentation of all claim activity, payer communications, and resolution efforts

Denial Prevention & Process Improvement

• Identify trends and recurring denial patterns by payer, specialty, coding category, or workflow issue
• Collaborate with billing, coding, and clinical teams to recommend solutions that prevent future denials
• Support process improvements, workflow updates, and education initiatives to improve revenue cycle performance

Appeals & Compliance

• Manage and track appeal activity to ensure timely completion and compliance with payer-specific requirements
• Review claim corrections and resubmissions for accuracy and adherence to CMS, payer, and regulatory guidelines
• Maintain knowledge of insurance policies, CPT, HCPCS, ICD-10 coding updates, and revenue cycle best practices

Reporting & Analysis

• Analyze denial trends, reimbursement patterns, and AR performance metrics
• Track key revenue cycle indicators, including denial rates, appeal outcomes, and accounts receivable aging
• Provide reporting insights and recommendations to leadership to support financial performance goals

Required Qualifications

• 2-4 years of experience in medical billing, claims processing, denial management, or accounts receivable within a healthcare or payer environment
• Strong understanding of commercial and government insurance payer guidelines
• Knowledge of CPT, HCPCS, and ICD-10 coding systems
• Experience using EMR/EHR systems, clearinghouses, and medical billing software
• Strong analytical, problem-solving, and communication skills with excellent attention to detail

Preferred Qualifications

• CPC, CPB, or other AAPC/AHIMA certification
• Experience managing high-volume claims or complex denial portfolios
• Prior experience in revenue integrity, appeals, or reimbursement analysis

Schedule

• Full-time, 40 hours per week
• Standard schedule with an 8:00 AM start time

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?