US Eye Accounts Receivable (AR) Appeals Specialist

Summary

Center For Sight is seeking an Accounts Receivable Appeals Specialist to manage denied healthcare insurance claims and support accurate reimbursement. The role involves analyzing denials, preparing and tracking appeals, documenting claim actions, monitoring payer requirements, and collaborating with management, insurers, and patients.

Responsibilities

• Analyze denied claims to determine the reason for denial
• Prepare and submit well-researched written appeals to insurance carriers
• Review coding, contracts, and medical records to support appeals
• Identify patterns and trends in denials to prevent future occurrences
• Collaborate with upper management to present coding issues
• Escalate unresolved denial issues and communicate payer policy changes
• Track and follow up on reconsiderations and appeals within standard billing cycles
• Stay current with payer guidelines, regulatory changes, and compliance standards
• Document all actions taken on claims and appeals clearly and accurately
• Participate in quality improvement initiatives and special projects
• Communicate effectively with internal management, insurance companies, and patients

Skills

• Demonstrated ability to do excessive walking, standing, bending and stooping
• While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear
• The employee is occasionally required to climb or balance, kneel and crouch
• The employee may be required to lift moderately heavy objects (50-90 pounds)
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus
• Ability to travel between locations may be necessary
• This is a full-time position. Typical days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M
• High School Diploma or GED Required
• Prior healthcare billing experience preferred
• Certified Procedural Coder preferred

Qualifications

Must Haves

• Demonstrated ability to do excessive walking, standing, bending and stooping
• While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear
• The employee is occasionally required to climb or balance, kneel and crouch
• The employee may be required to lift moderately heavy objects (50-90 pounds)
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus
• Ability to travel between locations may be necessary
• This is a full-time position. Typical days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M
• High School Diploma or GED Required

Nice to Haves

• Prior healthcare billing experience preferred
• Certified Procedural Coder preferred

Benefits

• 401(K) Company Match
• Medical and Dental Insurance
• Vision Benefits
• Flexible Spending
• Remote work may be considered for this position.