Medical Billing Specialist: AR Follow-up & Denials

Medical Billing Specialist:

AR Follow-up & Denials Virginia Pediatric Eye Center Virginia Beach, VA Job Details Part-time 1 day ago Benefits Health insurance Dental insurance 401(k) Paid time off Qualifications Revenue cycle management Managed care Process improvement Attention to detail Organizational skills Critical thinking Analytics Full Job Description Position Summary The Insurance AR & Denials Billing Specialist is responsible for managing and resolving insurance claim denials, ensuring accurate reimbursement, and optimizing revenue cycle performance. This role requires advanced analytical skills, persistence, and the ability to navigate complex payer requirements, including Virginia Medicaid, Managed Care Organizations (MCOs), and vision plans. The ideal candidate demonstrates strong problem-solving abilities and a proactive approach to addressing reimbursement challenges. Key Responsibilities Claims Management & Denial Resolution Review and analyze denied and underpaid claims to identify root causes and trends. Recognize and track denial patterns to inform process improvements and payer escalation strategies. Interpret and apply information from Explanation of Benefits (EOBs) to determine appropriate next steps. Prepare and submit timely appeals, reconsiderations, and corrected claims. Investigate and resolve claim retractions and recoupments, including formal dispute processes. Payer Communication & Advocacy Communicate effectively with insurance carriers to resolve claim issues and secure appropriate reimbursement. Advocate on behalf of the practice by challenging inappropriate denials and underpayments. Navigate payer policies across a wide range of commercial and government plans. Escalate unresolved or systemic issues to leadership with supporting documentation and recommendations. Patient Outreach Monitors self-pay account balances. Communicate with patients regarding account balances. Coordinates with Patient Accounts Specialist for unpaid balances. Medicaid & MCO Expertise Manage claims and denials related to Virginia Medicaid and associated Managed Care Organizations (MCOs). Ensure compliance with state-specific billing guidelines and payer requirements. Problem Solving & Process Improvement Apply critical thinking to develop creative solutions for complex reimbursement challenges. Manage multiple claims simultaneously while maintaining accuracy and timeliness. Collaborate with front-end staff, clinical teams, and leadership to prevent recurring billing issues. Contribute to the development of best practices for denial prevention and resolution. Qualifications Required Proven experience in medical billing and insurance follow-up. Strong understanding of Explanation of Benefits (EOBs) and payer adjudication processes. Demonstrated ability to identify denial patterns and implement corrective actions. Experience working with Virginia Medicaid and MCO claims. Ability to manage a high volume of claims with strong organizational skills. Excellent written and verbal communication skills. Persistent, solutions-oriented mindset with a willingness to challenge incorrect payer determinations. Preferred Experience with a wide range of commercial and government insurance products. Experience in ophthalmology billing (e.g., surgical and office-based coding) is a plus. Familiarity with retraction and recoupment dispute processes. Experience with practice management systems (e.g., Allscripts Practice Manager or similar).

Core Competencies Analytical Thinking:

Ability to evaluate complex claim scenarios and determine effective resolution strategies. Attention to

Detail:

High level of accuracy in reviewing claims, EOBs, and payer communications.

Resilience & Persistence:

Maintains follow-through on difficult claims and payer disputes.

Time Management:

Effectively prioritizes and manages multiple claims and deadlines.

Professional Judgment:

Recognizes when to escalate issues and engages leadership appropriately. Work Environment & Expectations Fast-paced healthcare environment requiring adaptability and efficiency. Regular interaction with billing team members, payers, and internal departments. Performance is measured by denial resolution rate, reimbursement recovery, turnaround time, and contribution to overall revenue cycle improvement. Position Impact This role plays a critical part in protecting practice revenue, reducing accounts receivable aging, and improving overall financial performance by ensuring that services rendered are appropriately reimbursed.

Benefits:

401(k) Dental insurance Health insurance Paid time off

Experience:

Medical Billing:

1 year (Required)

Work Location:

In person