United Surgical Partners International, Inc
AR Follow Up Specialist
United Surgical Partners International, Inc, Albuquerque, New Mexico, United States, 87101
Job Title
AR Follow Up Specialist
Reporting Relationship Reports to the Business Office Manager
Job Summary An insurance A/R Follow‑Up Specialist investigates and resolves unpaid or denied insurance claims to ensure proper payment and timely revenue‑cycle management. Key responsibilities include contacting insurance carriers on aged claims, analyzing EOBs and claim denials for discrepancies, researching coding issues, resubmitting claims, appealing denials based on payer and government regulations, and maintaining detailed account notes. A strong understanding of medical coding, billing software, and insurance payer requirements is essential.
Essential Duties and Responsibilities
Proactively contact insurance companies for payment on aging, unpaid, or rejected claims.
Investigate claim denials to identify coding errors, missing information, or payer issues.
Correct inaccurate demographic information or coding and resubmit claims that were rejected or not received by the payer.
Prepare and submit appeals for denied claims, often requiring physician or coder input for supporting medical‑necessity language.
Research network problems, work‑comp issues, and other complex claim issues to resolve them effectively.
Maintain detailed and concise notes on all account activities and communications with insurance carriers.
Ensure all actions adhere to federal, state, and payer‑specific regulations and guidelines.
Generate reports to monitor A/R trends and identify patterns in claim denials to improve processes.
Proficiency with medical billing software, practice‑management systems, and payer websites is required.
Research, analyse, and interpret claim data and EOBs to resolve discrepancies.
Excellent verbal and written communication skills to interact with insurance carriers and internal teams.
Strong understanding of medical terminology, coding (ICD‑10, CPT), and the billing/appeals process for commercial and government payers.
Ability to think critically and creatively to find solutions to complex billing issues.
High school diploma required; associate’s or bachelor’s degree in a related field preferred.
Job Behavior: Reflective of Mission Statement USPI’s mission is to provide first‑class surgical services for the local community in a safe, comfortable, and welcoming environment. Employees demonstrate teamwork, professionalism, flexibility, reliability, productivity, and self‑motivation while maintaining a professional conduct and appearance.
Language Skills Ability to read and interpret documents and correspondence, write routine reports and correspondence, memos, and communicate effectively with physicians, their staff, patients, and families.
Physical Demands The physical demands described here are representative of those required to successfully perform the essential functions of this job. Reasonable accommodations may be made. The employee occasionally lifts or moves up to 10 pounds.
What We Offer
Medical, dental, vision, and prescription coverage
Life and AD&D coverage
Short‑ and long‑term disability availability
Flexible financial benefits including FSAs and HSAs
401(k) and retirement‑planning access
Paid holidays and vacation
Who We Are At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first‑class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner, with an inclusive culture that values diversity.
Required Skills
Perform each essential duty satisfactorily.
Demonstrated computer skills.
High‑school education and/or equivalent; up to one year of related experience or training.
Seniority level Entry level
Employment type Full‑time
Job function Accounting/Auditing and Finance
Industries Hospitals and Health Care
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Reporting Relationship Reports to the Business Office Manager
Job Summary An insurance A/R Follow‑Up Specialist investigates and resolves unpaid or denied insurance claims to ensure proper payment and timely revenue‑cycle management. Key responsibilities include contacting insurance carriers on aged claims, analyzing EOBs and claim denials for discrepancies, researching coding issues, resubmitting claims, appealing denials based on payer and government regulations, and maintaining detailed account notes. A strong understanding of medical coding, billing software, and insurance payer requirements is essential.
Essential Duties and Responsibilities
Proactively contact insurance companies for payment on aging, unpaid, or rejected claims.
Investigate claim denials to identify coding errors, missing information, or payer issues.
Correct inaccurate demographic information or coding and resubmit claims that were rejected or not received by the payer.
Prepare and submit appeals for denied claims, often requiring physician or coder input for supporting medical‑necessity language.
Research network problems, work‑comp issues, and other complex claim issues to resolve them effectively.
Maintain detailed and concise notes on all account activities and communications with insurance carriers.
Ensure all actions adhere to federal, state, and payer‑specific regulations and guidelines.
Generate reports to monitor A/R trends and identify patterns in claim denials to improve processes.
Proficiency with medical billing software, practice‑management systems, and payer websites is required.
Research, analyse, and interpret claim data and EOBs to resolve discrepancies.
Excellent verbal and written communication skills to interact with insurance carriers and internal teams.
Strong understanding of medical terminology, coding (ICD‑10, CPT), and the billing/appeals process for commercial and government payers.
Ability to think critically and creatively to find solutions to complex billing issues.
High school diploma required; associate’s or bachelor’s degree in a related field preferred.
Job Behavior: Reflective of Mission Statement USPI’s mission is to provide first‑class surgical services for the local community in a safe, comfortable, and welcoming environment. Employees demonstrate teamwork, professionalism, flexibility, reliability, productivity, and self‑motivation while maintaining a professional conduct and appearance.
Language Skills Ability to read and interpret documents and correspondence, write routine reports and correspondence, memos, and communicate effectively with physicians, their staff, patients, and families.
Physical Demands The physical demands described here are representative of those required to successfully perform the essential functions of this job. Reasonable accommodations may be made. The employee occasionally lifts or moves up to 10 pounds.
What We Offer
Medical, dental, vision, and prescription coverage
Life and AD&D coverage
Short‑ and long‑term disability availability
Flexible financial benefits including FSAs and HSAs
401(k) and retirement‑planning access
Paid holidays and vacation
Who We Are At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first‑class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner, with an inclusive culture that values diversity.
Required Skills
Perform each essential duty satisfactorily.
Demonstrated computer skills.
High‑school education and/or equivalent; up to one year of related experience or training.
Seniority level Entry level
Employment type Full‑time
Job function Accounting/Auditing and Finance
Industries Hospitals and Health Care
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