AR Specialist - Triage & Investigations

Summary

Zotec Partners is a healthcare industry organization that partners with physicians to simplify the business of healthcare. The AR Specialist will triage Salesforce cases, investigate claim rejections and denials, resolve billing and correspondence issues, communicate with insurance carriers, and track appeals through resolution.

Responsibilities

• Review and triage Salesforce Cases, directing them to the appropriate teams or departments within the Enterprise
• Follow up on claims rejections and denials to determine cause and appropriate next action
• Identify billing issues and route or correct them as needed
• Communicate with insurance companies to obtain status on outstanding claims
• Work daily correspondence work files, prioritizing by age and dollar impact
• Process and follow up on appeals, tracking outcomes through resolution
• Resolve correspondence issues, including EOB discrepancies and payer requests for additional information
• Document all account activity clearly and accurately in the billing system
• Escalate trends or recurring denial patterns to leadership when identified
• Meet daily/weekly productivity and quality standards for case resolution

Skills

• Prior experience in medical billing, accounts receivable, or healthcare claims follow-up
• Working knowledge of insurance claim processes, EOBs, denial codes, and appeals procedures
• Familiarity with payer portals and/or clearinghouses
• Strong written and verbal communication skills for payer correspondence
• Comfort working in a high-volume, deadline-driven environment
• Detail-oriented with strong organizational and time-management skills
• Proficiency with Microsoft Excel and Salesforce
• Knowledge of CPT, ICD-10, and HCPCS coding
• Prior experience in a revenue cycle management (RCM) environment

Qualifications

Must Haves

• Prior experience in medical billing, accounts receivable, or healthcare claims follow-up
• Working knowledge of insurance claim processes, EOBs, denial codes, and appeals procedures
• Familiarity with payer portals and/or clearinghouses
• Strong written and verbal communication skills for payer correspondence
• Comfort working in a high-volume, deadline-driven environment
• Detail-oriented with strong organizational and time-management skills
• Proficiency with Microsoft Excel and Salesforce

Nice to Haves

• Knowledge of CPT, ICD-10, and HCPCS coding
• Prior experience in a revenue cycle management (RCM) environment