The Senior Associate – AR & Billing is responsible for managing insurance claim follow-up, payment posting support, denial resolution, and billing activities to ensure timely reimbursement and minimize aging accounts receivable. The role requires strong knowledge of medical billing, payer guidelines, denial management, and revenue cycle workflows.
Billing Responsibilities
- Review and submit clean claims to insurance payers electronically and manually.
- Verify patient demographics, insurance details, authorizations, and eligibility.
- Ensure accurate CPT, ICD-10, and modifier usage as per payer guidelines.
- Identify and correct claim edits, rejections, and billing errors.
- Work on charge entry corrections and claim resubmissions.
- Coordinate with coding, front desk, and payer enrollment teams for claim resolution.
- Maintain billing productivity and accuracy standards.
AR Responsibilities
- Perform insurance follow-up on outstanding claims with commercial, Medicare, Medicaid, and managed care payers.
- Analyze denials and take appropriate corrective actions for resolution.
- Handle appeals, reconsiderations, corrected claims, and medical records submissions.
- Review EOBs/ERAs and identify underpayments or payment discrepancies.
- Work aging reports and prioritize high-dollar and timely filing accounts.
- Escalate unresolved or complex issues to management when required.
- Ensure compliance with payer turnaround times and internal SLA requirements.
Additional Responsibilities
- Maintain detailed account documentation in billing systems.
- Support month-end AR cleanup and reporting activities.
- Train and guide junior associates on payer processes and denial handling.
- Participate in process improvement initiatives and team meetings.
- Ensure HIPAA compliance and maintain patient confidentiality.
Required Qualifications
- Bachelor’s degree or equivalent experience preferred.
- 3–5 years of experience in Medical Billing and AR within RCM.
- Strong understanding of:
- CPT, ICD-10, and HCPCS coding basics
- Denial management
- Insurance claim lifecycle
- Medicare, Medicaid, and commercial payer guidelines
- Experience with EMR/EHR and billing software such as Epic, ECW, Athena, NextGen, Kareo, etc.
- Proficiency in Microsoft Excel and reporting tools.
