US Eye Accounts Receivable (AR) Appeals Specialist

Accounts Receivable (AR) Appeals Specialist

POSITION SUMMARY:

The AR Appeals Specialist is responsible for managing denied insurance claims, preparing and submitting reconsiderations & appeals, and ensuring accurate reimbursement for healthcare services. This role requires strong analytical skills, knowledge of medical billing and coding, and the ability to navigate payer policies and systems.

KEY RESPONSIBILITIES:

CLAIMS REVIEW & APPEALS:

• Analyze denied claims to determine the reason for denial.
• Prepare and submit well-researched written appeals to insurance carriers.
• Review coding, contracts, and medical records to support appeals

DENIAL MANAGEMENT:

• Identify patterns and trends in denials to prevent future occurrences.
• Collaborate with upper management to present coding issues.
• Escalate unresolved denial issues and communicate payer policy changes

ACCOUNTS RECEIVABLE FOLLOW-UP:

• Track and follow up on reconsiderations and appeals within standard billing cycles.

COMPLIANCE & DOCUMENTATION:

• Stay current with payer guidelines, regulatory changes, and compliance standards.
• Document all actions taken on claims and appeals clearly and accurately.
• Participate in quality improvement initiatives and special projects

COMMUNICATION & COLLABORATION:

• Communicate effectively with internal management, insurance companies, and patients.

SUPERVISORY RESPONSIBILITIES:

The position has no supervisory responsibilities.

WORK ENVIRONMENT:

The work characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Fast-paced, deadline oriented, confidential department. The noise level in the work environment is usually moderate.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Demonstrated ability to do excessive walking, standing, bending and stooping. While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear. The employee is occasionally required to climb or balance, kneel and crouch.

The employee may be required to lift moderately heavy objects (50-90 pounds). Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

The employee will be required to work in an office environment or remotely as need. Ability to travel between locations may be necessary.

Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.

POSITION TYPE AND EXPECTED HOURS OF WORK:

This is a full-time position. Typical days and hours are Monday through Friday 8:00 A.M. - 5:00 P.M. Remote work may be considered for this position.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

TRAVEL:

Travel to the office as necessary.

EDUCATION AND EXPERIENCE:

• High School Diploma or GED Required.
• Prior healthcare billing experience preferred.
• Certified Procedural Coder preferred.

BENEFITS:

US EYE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

• 401(K) Company Match
• Medical and Dental Insurance
• Vision Benefits
• Flexible Spending