A/R Specialist III

Dermatology Associates Of Concord - Concord, MA

Full-time - Mid Level

Concord, MA

Ambulatory Health Care Services

About the position

The A/R Specialist III at Dermatology Associates of Concord is a vital role responsible for managing comprehensive billing, collections, auditing, and accounting functions within the organization. This position requires a proactive approach to follow up on insurance accounts, which includes researching past due claims, contacting insurance companies, and assisting patients in coordinating their benefits. The specialist will reconcile EDI files and post insurance payments using practice management software, ensuring that all billing records are accurate and current. The role also involves verifying claims and medical codes, submitting insurance claims, responding to insurance requests and audits, processing payments, writing timely appeals, and entering data on patient accounts. The A/R Specialist III will be coding general and surgical dermatology encounters, as well as dermatopathology, phototherapy, and cosmetic services. In addition to these responsibilities, the A/R Specialist III will provide audit support for the revenue cycle manager and interface sensitively with providers. They will act as the primary resource for administrative staff regarding insurance queries and will reconcile charges in both practice management software and EMR systems. The specialist is expected to maintain productivity and accuracy standards while ensuring that discrepancies are tracked and resolved efficiently. Essential duties include answering billing phone calls, supporting registration and call center admins with eligibility and referral queries, submitting claims to insurance companies and third-party payers, coding and filing patient encounters, and maintaining compliance with established policies and procedures. The A/R Specialist III will also be responsible for obtaining prior approval for surgical encounters and keeping abreast of payer policy changes through monthly newsletters. This role does not have supervisory responsibilities but requires a strong foundation in medical billing and coding, as well as excellent organizational and communication skills.

Responsibilities

• Perform comprehensive billing, collections, auditing, and accounting functions.
• Follow up on insurance accounts by researching past due claims and contacting insurance companies.
• Assist patients in coordinating benefits.
• Reconcile EDI files and post insurance payments in practice management software.
• Verify claims and medical codes, and handle coding-based appeals.
• Submit insurance claims and respond to insurance requests and audits.
• Process payments, write timely appeals, and enter data on patient accounts.
• Code general and surgical dermatology encounters, dermatopathology, phototherapy, and cosmetic services.
• Provide audit support for the revenue cycle manager and interface with providers.
• Act as the primary resource for admin staff with insurance queries.
• Reconcile charges in practice management software and EMR.
• Ensure billing records are accurate and current, and track and resolve discrepancies.
• Answer billing phone calls and support registration and call center admins with eligibility and referral queries.
• Submit claims to insurance companies and third-party payers for reprocessing.
• Maintain productivity and accuracy standards in billing processes.
• Query providers for coding clarification and render patient estimates.
• Review all EDI rejections and resubmit with corrections.
• Process insurance payments via EDI and reconcile accounts.
• Enter insurance claims, payments, adjustments, and denials on patient statements.
• Check electronic billing and payment reports for accuracy.
• Follow up with third party payers to ensure timely collections.
• Write and follow up on third party payer appeals.
• Obtain prior approval for surgical encounters and stay updated on payer policy changes.

Requirements

• Associate degree or equivalent in medical office billing experience.
• CPC, CCA, or CPB certification required.
• At least 3-5 years of medical billing experience.
• Knowledge of medical billing and Massachusetts payer policies.
• Familiarity with EDI, medical coding, and insurance claim filing.
• Understanding of basic accounting concepts and related computer applications.
• Strong time management and organizational skills.
• Ability to rapidly adapt to new technologies and work independently.
• Solid data entry and typing skills, with accuracy in ten-key by touch.
• Good communication and public relations abilities.

Nice-to-haves

• Experience with Office 365 and advanced Microsoft Office skills.
• Detail-oriented with strong analytical skills.