Job Summary:

The AR Representative/RCM Specialist is responsible for managing the front-end and back-end billing processes, ensuring accurate authorization, claim submission, and denial management. The ideal candidate will have a strong understanding of medical billing, coding, and authorization processes within the healthcare industry.

Key Responsibilities:

Front End - Authorizations:

• Manage and process referrals and authorizations for patient services.
• Verify eligibility and benefits for services rendered.
• Collaborate with healthcare providers to obtain necessary authorizations.
• Utilize authorization portals (e.g., Carelon) to track and manage authorizations.
• Ensure timely communication with patients regarding authorization status.

Front End - Billing:

• Perform claim submissions for various services.
• Understand claim processing procedures and ensure compliance with billing standards.
• Post payments accurately and reconcile accounts.
• Analyze Explanation of Benefits (EOB) statements and resolve discrepancies.
• Ensure adherence to billing and coding guidelines.

Back End - Billing:

• Manage Accounts Receivable (AR) and denial resolution processes.
• Review and understand billing guidelines for Medicare, BCBS, UHC, Aetna, etc.
• Familiarize with documentation requirements related to sleep studies (e.g., RX, Titration/ Polysomnogram, etc.)
• Prepare and submit appeals for denied claims based on insurance requirements.
• Maintain accurate records of appeals and follow-up actions.

Please refer to job description.