The AR Specialist I plays a key role in supporting revenue cycle management initiatives. This individual is responsible for ensuring that insurance claims are processed through to resolution in accordance with client contracts, internal policies and procedures, and state and federal regulations. Core responsibilities include eligibility and coverage verification, accurate claim submission and resubmission, and resolution of rejected claims. The AR Specialist I is expected to manage their workload efficiently to meet project deadlines and maintain high-quality standards.
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High School Diploma or equivalent required.
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Bachelor’s degree in Business, Finance, or related field preferred (or equivalent experience).
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Completion of onboarding and training programs.
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10 hours of continuing education/training annually.
Position Summary:
The AR Specialist I plays a key role in supporting revenue cycle management initiatives. This individual is responsible for ensuring that insurance claims are processed through to resolution in accordance with client contracts, internal policies and procedures, and state and federal regulations. Core responsibilities include eligibility and coverage verification, accurate claim submission and resubmission, and resolution of rejected claims. The AR Specialist I is expected to manage their workload efficiently to meet project deadlines and maintain high-quality standards.
Essential Duties and Responsibilities:
Account Responsibilities:
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Verify eligibility and coverage using designated systems and client-specific procedures.
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Enter charges and post payments accurately and timely, as per client requirements.
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Submit and resubmit clean, accurate claims per payer and client-specific instructions.
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Follow up on claim status per project guidelines to ensure timely resolution.
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Address and resolve denied claims per established procedures; escalate patterns of excessive denials.
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Work through all correspondence received via client systems according to protocols.
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Resolve credit balances and prepare required documentation in compliance with procedures.
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Account Goals:
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Complete monthly ATB and 180-day ATB tasks.
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Understand and articulate client contract deliverables and obligations.
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Provide high-quality customer service by effectively resolving insurance and billing issues.
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Maintain high accuracy in quality assurance audits.
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Analyze denial trends and communicate findings for process improvement.
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Collaborate with team members to identify and implement efficiency improvements.
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Customer Service Responsibilities:
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Professionally answer inbound calls and respond to inquiries from patients and insurers.
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Make daily outbound calls as assigned to address billing or claim issues.
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Maintain a customer-focused attitude and build positive client relationships.
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Position Success Factors:
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Meet or exceed 85% productivity and workload task goals, as measured by monthly scorecards.
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Stay within 2% of budgeted hours for each assigned project.
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Core Competencies:
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Proficient in handling one client project and system.
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Familiarity with one payer and its portal.
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Ability to manage conflicting claims and denial categories.
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Skilled in making insurance-related outbound calls.
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Maintain 85% production standards and 10/hour ATB task rates.
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Achieve and maintain 92% or higher on quality audits.
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Professional Qualities:
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Demonstrates initiative, effective communication, and alignment with company core values.
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Communicates effectively with stakeholders at all organizational levels.
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Certifications:
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Certified Professional Financial Services Specialist (to be obtained within the first year of employment).
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Skills and Experience:
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General understanding of accounting principles is preferred.
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Strong organizational, analytical, and decision-making abilities.
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Proficiency with Microsoft Office tools (Word, Excel, Outlook).
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Ability to manage multiple tasks and deadlines with minimal supervision.
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Excellent written and verbal communication skills.
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Education / Training:
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High School Diploma or equivalent required.
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Bachelor’s degree in Business, Finance, or related field preferred (or equivalent experience).
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Completion of onboarding and training programs.
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10 hours of continuing education/training annually.
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Maintain a minimum 92% quality audit score.
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Achieve resolution rate benchmarks at 30 and 60 days.
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Complete compliance and security training on time.
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Maintain regular attendance and adhere to assigned work schedule at least 92% of the time.
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Demonstrate consistent scorecard performance.
