AR Specialist

Job Details: Job Location: Remote - Capitol Billing Group - Metairie, LA, Position Type: Full Time, Salary Range: Undisclosed, Job Shift: Day, Medical Accounts Receivable (A/R) Revenue Specialist  Position Summary  The Medical Accounts Receivable (A/R) Revenue Specialist is responsible for managing and optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Specialist works to maximize cash flow while ensuring compliance with payer requirements and organizational policies.    Key Responsibilities  Claims & Vendor Management  Partner with external billing vendors to address claim rejections and payer requests for clarification.  Provide guidance and feedback to vendor partners on claim corrections, rework, and resubmissions.  Review escalated accounts requiring internal oversight or final resolution.  Denial Management & Appeals  Collaborate with vendor partners to identify denial trends, recurring payer issues, and root causes.  Provide feedback and strategic direction on appeal approaches and payment resolution tactics.  Authorize final adjustments after all appeal opportunities have been exhausted, ensuring appropriate documentation and compliance.  Recommend process improvements to reduce future denials.  Accounts Receivable Follow-Up  Proactively work A/R aging reports (30, 60, 90+ days) to identify unpaid or underpaid claims.  Initiate payer tracers and follow-ups to secure claim adjudication and payment.  Monitor high-risk and high-dollar accounts to prevent revenue leakage.  Payment Posting & Reconciliations  Ensure accurate posting and reconciliation of insurance and patient payments.  Transfer payments to patient balances when appropriate and process patient refunds in compliance with policy.  Assist with account reconciliations and discrepancies resolution as needed.    Patient & Insurance Communication  Act as a liaison between patients and insurance payers to resolve billing questions.  Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.  Conduct professional and empathetic phone communication with patients and payer representatives.    Qualifications & Requirements  Education  High School Diploma or equivalent required  Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred  Experience  1–3 years of experience in:   Medical billing and collections  Accounts Receivable or Revenue Cycle Management  Healthcare payer follow-up and denial resolution  Technical Skills  Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)  Strong working knowledge of Microsoft Office, particularly:   Excel (reports, aging analysis)  SharePoint  Medical & Regulatory Knowledge  Working knowledge of:   Medical terminology  CPT and ICD-10 coding  Payer guidelines and reimbursement rules for Medicare, Medicaid, and Commercial Insurance plans  Core Competencies  Strong analytical and problem-solving skills  Exceptional attention to detail and accuracy  Effective written and verbal communication skills  Ability to work collaboratively with internal teams and external vendor partners  Sound judgment related to financial adjustments and account resolution    Qualifications: