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Accounts Research Specialist
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- The Accounts Research Specialist are responsible for accounts research of physician services by researching denials for resolution and providing customer service to patients, insurance companies, third parties, providers and their offices.
- The employee will appeal denials appropriately, identify and report denial trends to management, notating on guarantor/patient accounts of research and resolution of claim(s), resolve insurance and patient credits, answer and resolve account inquiries, and handle secondary insurance claims process.
- Research and resolve all types of denials efficiently and accurately, which includes but not limited to coordination of benefits (COB), insurance eligibility, coding (e.g., modifiers, diagnoses, CCI edits), billing (e.g., NPI, POS, DOS).
- Follow insurance appeal standards or protocols, establish an appeal correspondence to petition the denial as incorrect or inappropriate and for the third-party carrier to reconsider and adjudicate the claim correctly.
- May inquire with assigned coder for education or letter of appeal, if outside the scope of the AR Specialist.
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