AR Specialist Athena

POSITION SUMMARY

The Accounts Receivable Specialist is responsible for resolving outstanding insurance accounts receivable within the AthenaOne platform. Working within Commonwealth’s co-sourced Revenue Cycle Management model, this position partners with Athenahealth Collector Services while maintaining ownership of complex claims, denials, payer escalations, appeals, underpayments, and reimbursement issues.

The AR Specialist helps reduce AR aging, prevent avoidable write-offs, improve cash flow, and maximize reimbursement through timely follow-up, accurate documentation, and effective claim resolution.

ESSENTIAL RESPONSIBILITIES

• Manage and prioritize assigned AthenaOne insurance AR worklists, with emphasis on high-dollar, denied, aging, and timely filing-risk claims.
• Review and resolve unpaid, denied, partially paid, underpaid, and aging claims.
• Conduct claim follow-up through payer portals, telephone calls, and other available resources.
• Submit corrected claims, reconsideration requests, and appeals with appropriate supporting documentation.
• Resolve complex eligibility, authorization, coding, modifier, medical necessity, timely filing, coordination of benefits, and duplicate claim denials.
• Identify denial root causes, implement corrective actions, and escalate recurring trends to leadership.
• Review payment accuracy, investigate contract variances, and pursue reimbursement discrepancies and underpayments.
• Escalate unresolved or stalled claims to payer representatives, provider relations contacts, or internal leadership as appropriate.
• Partner with Athenahealth Collector Services and address vendor-related performance or account resolution concerns.
• Maintain complete, accurate, and actionable account documentation in AthenaOne.
• Monitor follow-up dates and timely filing requirements to prevent missed deadlines and avoidable write-offs.
• Identify opportunities to reduce revenue leakage, repeat denials, and unnecessary rework.

REQUIRED QUALIFICATIONS

• High school diploma or equivalent.
• At least two years of healthcare accounts receivable experience.
• At least one year of experience using AthenaOne.
• Experience with physician practice billing.
• Knowledge of insurance billing, payer requirements, and denial resolution.
• Working knowledge of medical terminology, CPT, ICD-10, and modifiers.
• Ability to navigate payer portals and interpret claim and payment information.
• Strong analytical, problem-solving, organizational, and documentation skills.
• Effective written and verbal communication skills.
• Ability to prioritize reimbursement opportunities and manage multiple accounts and deadlines.

PREFERRED QUALIFICATIONS

• Associate degree.
• Experience working within a co-sourced or outsourced Revenue Cycle Management model.
• Experience in pain management, orthopedics, ambulatory surgery centers, or another specialty practice.
• Experience with clinical appeals, contract variance analysis, or payer escalations.

PERFORMANCE EXPECTATIONS

Performance is measured through productivity, follow-up timeliness, documentation quality, claim resolution, collections, denial outcomes, and contribution to departmental AR aging goals. The AR Specialist is expected to demonstrate ownership of account outcomes, escalate issues appropriately, and consistently prioritize high-value reimbursement opportunities.

CORE COMPETENCIES

• Accountability
• Attention to detail
• Analytical thinking
• Problem-solving
• Collaboration
• Professional communication
• Integrity
• Continuous improvement
• Results orientation