Revenue Cycle Specialist

POSITION SUMMARY
The AR & Denials Specialist is responsible for the timely and accurate follow-up and resolution of outstanding insurance accounts receivable and denied claims across assigned practices and payers.

This position requires strong hands-on experience with eClinicalWorks (eCW) and insurance payer portals. The ideal candidate is an experienced AR professional who can independently review an account, understand the claim history, determine why payment has not been received, identify the appropriate next step, and work the account toward resolution with minimal supervision.

This role is best suited for someone who is comfortable taking ownership of an assigned payer or work queue and who already understands the fundamentals of medical insurance AR and denial management.

ESSENTIAL DUTIES AND RESPONSIBILITIES
• Independently work assigned AR and denial work queues within eClinicalWorks.
• Research unpaid, denied, rejected, and underpaid insurance claims.
• Review claim history, remittance information, EOBs, account notes, and previous follow-up activity to determine the appropriate next action.
• Utilize insurance payer portals to research claim status, denials, correspondence, and additional documentation requests.
• Identify and respond to payer requests for medical records and supporting documentation.
• Upload medical records and other requested documentation through payer portals.
• Prepare and submit corrected claims, reconsiderations, and appeals as appropriate.
• Interpret EOBs, ERAs, CARC/RARC codes, and payer denial information.
• Research payer policies and billing requirements as necessary to resolve outstanding claims.
• Identify issues related to eligibility, authorization, referrals, timely filing, coordination of benefits, coding, medical necessity, credentialing, and payer 
processing.
• Follow claims through resolution rather than completing repetitive status follow-up.
• Maintain clear, complete, and accurate documentation within eClinicalWorks.
• Escalate accounts appropriately after reasonable independent research and follow-up have been completed.
• Identify recurring payer or denial trends and communicate potential systemic issues to RCM leadership.
• Collaborate with coding, claim submission, practice operations, and other revenue cycle teams when additional intervention is required.
• Maintain established productivity and quality expectations.
• Perform other duties as assigned.

REQUIRED QUALIFICATIONS
• Minimum of 2 years of medical insurance AR and/or denial management experience.
• Strong hands-on experience with eClinicalWorks (eCW).
• Experience independently working insurance accounts receivable and denied claims.
• Strong experience using insurance payer portals.
• Demonstrated expertise working with at least one commercial or government insurance payer.
• Experience with appeals, reconsiderations, corrected claims, and payer follow-up.
• Experience identifying and responding to medical-record or additional documentation requests.
• Ability to read and interpret EOBs, ERAs, and denial reason codes.
• Working knowledge of the medical claim lifecycle.
• Strong research, critical-thinking, and problem-solving skills.
• Ability to independently review an account and determine the appropriate next action.
• Strong written documentation and communication skills.
• Ability to organize and prioritize a high-volume workload.
• Ability to work independently and effectively in a fully remote environment.

PREFERRED QUALIFICATIONS
• ENT and/or allergy revenue cycle experience strongly preferred.
• Experience working within a multi-practice or MSO environment.
• Experience working aged or complex insurance AR.
• Medicare and/or Medicaid experience.
• Working knowledge of CPT, ICD-10-CM, modifiers, and professional claim billing.
• Experience identifying payer trends and root causes of recurring denials.
 

KNOWLEDGE, SKILLS, AND ABILITIES
• Advanced ability to navigate eClinicalWorks for AR and denial follow-up.
• Strong understanding of insurance follow-up and denial resolution.
• Ability to research unfamiliar payer issues independently.
• Ability to interpret payer responses and determine appropriate corrective action.
• Strong attention to detail and account documentation.
• Ability to distinguish between an account that can be independently resolved and one requiring escalation.
• Demonstrated accountability and ownership of assigned work.
• Ability to adapt to multiple practices, payers, and workflows.
• Strong time-management skills in a remote environment.